Active NPI
Maryam Fazal, DMD
- General Practice Dentistry
- Mesquite, TX
National Provider Identifier
1063930972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 32873
- Practice address
- 3220 Gus Thomasson Rd
Mesquite, TX 75150-4057 - Phone
- (817) 222-9900
- NPI assigned
- Aug 31, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 32873 | TX | Primary |
Addresses
Primary practice location
3220 Gus Thomasson Rd
Mesquite, TX 75150-4057
Mailing address
9226 Greenville Ave
Dallas, TX 75243-7151
Phone (214) 336-3361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170923000485 | TX | Order and Referring Only - Dentist | 5698049070 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1063930972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9226 GREENVILLE AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752437151",
"telephone_number": "214-336-3361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 GUS THOMASSON RD",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751504057",
"telephone_number": "817-222-9900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZAL",
"first_name": "MARYAM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-31",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "32873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.