| Village Dds Pllc | |
|
4041 W Wheatland Rd Suite 202 Dallas TX 75237-4063 | |
| (817) 306-1738 | |
| (817) 306-7366 |
| Full Name | Village Dds Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4041 W Wheatland Rd, Dallas, Texas |
| Authorized Official Name and Position | Omar Fetouh (OWNER) |
| Authorized Official Contact | 7163489855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Dds Pllc 4041 W Wheatland Rd Suite 202 Dallas TX 75237-4063 Ph: (817) 306-1738 | Village Dds Pllc 4041 W Wheatland Rd Suite 202 Dallas TX 75237-4063 Ph: (817) 306-1738 |
| NPI Number | 1396101010 |
|---|---|
| Provider Enumeration Date | 01/11/2016 |
| Last Update Date | 01/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396101010 | NPI | - | NPPES |
| 1568871523 | Medicaid | TX | |
| 1992950042 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30316 (Texas) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 24314 (Texas) | Primary |
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