Basic Information
Provider Information
NPI: 1629443924
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARADI
FirstName: ASEEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 FM 300
Address2:  
City: LEVELLAND
State: TX
PostalCode: 79336
CountryCode: US
TelephoneNumber: 8068947842
FaxNumber: 8068943378
Practice Location
Address1: 1000 FM 300
Address2:  
City: LEVELLAND
State: TX
PostalCode: 793366235
CountryCode: US
TelephoneNumber: 8068947842
FaxNumber: 8068943378
Other Information
ProviderEnumerationDate: 12/11/2015
LastUpdateDate: 12/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X31560TXY Dental ProvidersDentist 

No ID Information.


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