Provider Demographics
NPI:1780491613
Name:OAK GROUP DENTAL PLLC
Entity type:Organization
Organization Name:OAK GROUP DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:Q
Authorized Official - Last Name:NASERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-691-3696
Mailing Address - Street 1:18640 LYNDON B JOHNSON FWY STE 202
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5631
Mailing Address - Country:US
Mailing Address - Phone:972-288-4401
Mailing Address - Fax:
Practice Address - Street 1:18640 LYNDON B JOHNSON FWY STE 202
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5631
Practice Address - Country:US
Practice Address - Phone:972-288-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty