My Teeth Dental Orthodontics PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

24314 Issued in TX

Legal business name

MY TEETH DENTAL ORTHODONTICS PLLC

Practice address

2063 Town East Mall Ste 1036
Mesquite, TX 75150-4118

Phone

(716) 348-9855

NPI assigned

May 26, 2016

Last updated

Apr 15, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar FetouhNPI 1992950042

Title

Ceo

Phone

(716) 348-9855

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omar Fetouh, D.D.S

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Saginaw, TX
  • NPI 1992950042
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492214400000",
    "number": "1053769356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2063 TOWN EAST MALL STE 1036",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504118",
            "telephone_number": "716-348-9855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2063 TOWN EAST MALL STE 1036",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504118",
            "telephone_number": "716-348-9855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY TEETH DENTAL ORTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2017-04-15",
        "status": "A",
        "authorized_official_last_name": "FETOUH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "716-348-9855"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891810263",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alecia Nicole Murray, PHARMD
• Amber Kay Murray, MS, RDN, LD
• Glory Murray
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• My Pharmacy
• Jaclyn Brooke Myers, M.A., CCC-SLP
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• Reza Nabavi, P.T.
• Samer M Nachawati, DO

• General Practice Dentistry in Mesquite, TX
• Providers in Mesquite, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.