Provider Demographics
NPI:1861988073
Name:LAS COLINAS FAMILY DENTISTRY AND ORTHODONTICS PLLC
Entity type:Organization
Organization Name:LAS COLINAS FAMILY DENTISTRY AND ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:RAGHID
Authorized Official - Last Name:ALOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-919-0402
Mailing Address - Street 1:6421 RIVERSIDE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3501
Mailing Address - Country:US
Mailing Address - Phone:972-919-0402
Mailing Address - Fax:469-779-9495
Practice Address - Street 1:6421 RIVERSIDE DR STE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3501
Practice Address - Country:US
Practice Address - Phone:972-919-0402
Practice Address - Fax:469-779-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty