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Dental Providers Dentist General Practice

Provider NPI: 1396715702

Organization Information:
Organization is Subpart
Authorized Official:  RACHEL  NITTINGER  MANAGER CREDENTIALING  972-755-0816

Practice Location:
Tel: 313-389-9660  Fax: 216-584-1045

Business Mailing Address:
7160 DALLAS PKWY STE 400  PLANO, TX 75024-7111 US
Tel: --  Fax: --

NPI Information:
NPI: 1396715702
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N1223G0001XDental Providers
General Practice
N1223P0221XDental Providers
N1223E0200XDental Providers
N1223P0300XDental Providers
N1223P0700XDental Providers
N1223X0400XDental Providers
Y122300000XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 122300000X





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