Provider Demographics
NPI:1790352920
Name:DENTAL INNOVATION OF PLANO
Entity type:Organization
Organization Name:DENTAL INNOVATION OF PLANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-237-3558
Mailing Address - Street 1:2012 SOUTHLAKE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1422
Mailing Address - Country:US
Mailing Address - Phone:504-237-3558
Mailing Address - Fax:
Practice Address - Street 1:5940 W PARKER RD STE 103
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6404
Practice Address - Country:US
Practice Address - Phone:214-619-6329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty