Provider Demographics
NPI:1750873782
Name:MINEOLA DENTAL PLLC
Entity type:Organization
Organization Name:MINEOLA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-946-9375
Mailing Address - Street 1:5113 CEDAR BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2962
Mailing Address - Country:US
Mailing Address - Phone:423-946-9375
Mailing Address - Fax:
Practice Address - Street 1:344 NW LOOP 564 STE 400
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1128
Practice Address - Country:US
Practice Address - Phone:903-948-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26309OtherTEXAS STATE BOARD OF DENTAL EXAMINERS