Provider Demographics
NPI:1831568302
Name:PREVENTIVE GREEN DENTAL CARE INC
Entity type:Organization
Organization Name:PREVENTIVE GREEN DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-MUQDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-769-1073
Mailing Address - Street 1:2520 K AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2520 K AVE STE 180
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5378
Practice Address - Country:US
Practice Address - Phone:708-769-1073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty