Provider Demographics
NPI:1053535815
Name:AL-TAMIMI, MAYADA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAYADA
Middle Name:
Last Name:AL-TAMIMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-1712
Mailing Address - Country:US
Mailing Address - Phone:972-840-6800
Mailing Address - Fax:
Practice Address - Street 1:2001 S GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-1712
Practice Address - Country:US
Practice Address - Phone:972-840-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice