Healthcare Provider Details

I. General information

NPI: 1043840069
Provider Name (Legal Business Name): THRIVE DENTAL ALLEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W EXCHANGE PKWY #130
ALLEN TX
75013
US

IV. Provider business mailing address

5822 VICKERY BLVD
DALLAS TX
75206-6336
US

V. Phone/Fax

Practice location:
  • Phone: 323-898-3102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN COUGHLIN
Title or Position: OWNER
Credential: DDS
Phone: 323-898-3102