Provider Demographics
NPI:1619787645
Name:DENTIST IN MESQUITE LLC
Entity type:Organization
Organization Name:DENTIST IN MESQUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:EAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-333-6158
Mailing Address - Street 1:1927 FAITHON P LUCAS SR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1698
Mailing Address - Country:US
Mailing Address - Phone:469-333-6158
Mailing Address - Fax:469-333-6159
Practice Address - Street 1:1927 FAITHON P LUCAS SR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1698
Practice Address - Country:US
Practice Address - Phone:469-333-6158
Practice Address - Fax:469-333-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty