Provider Demographics
NPI:1447371315
Name:MACHADO, IRELIA MARIA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:IRELIA
Middle Name:MARIA
Last Name:MACHADO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 CHASE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8296
Mailing Address - Country:US
Mailing Address - Phone:817-656-4265
Mailing Address - Fax:817-656-4265
Practice Address - Street 1:324 MEDALLION CENTER
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:214-368-4331
Practice Address - Fax:214-368-4661
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics