Healthcare Provider Details

I. General information

NPI: 1144307281
Provider Name (Legal Business Name): DENTAL ONE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 W APACHE TRL SUITE 1
APACHE JUNCTION AZ
85220-3623
US

IV. Provider business mailing address

6700 PINECREST DR STE 150
PLANO TX
75024-4264
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-1111
  • Fax: 480-671-1657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18458
License Number StateTX

VIII. Authorized Official

Name: LAUREN HILL
Title or Position: DIRECTOR, RCM
Credential:
Phone: 972-930-7707