NPIMap

Organization Active NPI

Pearl Dental Clinic

  • Dentist
  • Garland, TX
National Provider Identifier
1306024948
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19596 Issued in TX
Legal business name
PEARL DENTAL CLINIC
Practice address
5402 Broadway Blvd
Garland, TX 75043-3637
Phone
(972) 303-3600
Fax
(972) 303-3607
NPI assigned
Feb 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

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

Authorized official

Name
Mr. Mahdi G Dezham, D.D.S
Title
President
Phone
(972) 303-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 19596 TX Primary

Addresses

Primary practice location

5402 Broadway Blvd
Garland, TX 75043-3637

Mailing address

5402 Broadway Blvd
Garland, TX 75043-3637
Phone (972) 303-3600

National Provider Directory

National Provider Directory

Locations

5402 Broadway Blvd
Garland, TX 75043
Phone (972) 303-3600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1306024948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5402 BROADWAY BLVD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750433637",
            "telephone_number": "972-303-3600",
            "fax_number": "972-303-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5402 BROADWAY BLVD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750433637",
            "telephone_number": "972-303-3600",
            "fax_number": "972-303-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "DEZHAM",
        "authorized_official_first_name": "MAHDI",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-303-3600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "19596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.