Provider Demographics
NPI:1740844760
Name:NOVASMILE DENTAL PLLC
Entity type:Organization
Organization Name:NOVASMILE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDALAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-876-2947
Mailing Address - Street 1:6772 PLAZA VIA
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3127
Mailing Address - Country:US
Mailing Address - Phone:818-876-2947
Mailing Address - Fax:
Practice Address - Street 1:2131 N COLLINS ST STE 415
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2811
Practice Address - Country:US
Practice Address - Phone:817-801-1382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty