Provider Demographics
NPI:1154760247
Name:EAST GRAND FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:EAST GRAND FAMILY DENTISTRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-668-3003
Mailing Address - Street 1:5429 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-239-0755
Practice Address - Street 1:5429 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-1914
Practice Address - Country:US
Practice Address - Phone:214-377-7312
Practice Address - Fax:214-377-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty