Provider Demographics
NPI:1285077693
Name:POONAM RAI LLC
Entity type:Organization
Organization Name:POONAM RAI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-874-1890
Mailing Address - Street 1:2704 CROSS TIMBERS RD
Mailing Address - Street 2:#108
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2756
Mailing Address - Country:US
Mailing Address - Phone:972-874-1890
Mailing Address - Fax:972-874-0839
Practice Address - Street 1:2704 CROSS TIMBERS RD
Practice Address - Street 2:#108
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2756
Practice Address - Country:US
Practice Address - Phone:972-874-1890
Practice Address - Fax:972-874-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty