Provider Demographics
NPI:1780084814
Name:ALGAISSI, D.M.D, P.C
Entity type:Organization
Organization Name:ALGAISSI, D.M.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGAISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-875-5074
Mailing Address - Street 1:8325 ESTANDARTE CT
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1672
Mailing Address - Country:US
Mailing Address - Phone:817-875-5074
Mailing Address - Fax:
Practice Address - Street 1:664 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5851
Practice Address - Country:US
Practice Address - Phone:817-426-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty