Healthcare Provider Details

I. General information

NPI: 1528642683
Provider Name (Legal Business Name): EMILEE HRTYANSKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GASTON AVE
DALLAS TX
75246-2013
US

IV. Provider business mailing address

2410 TAYLOR ST APT 22413
DALLAS TX
75201-8460
US

V. Phone/Fax

Practice location:
  • Phone: 214-828-8100
  • Fax:
Mailing address:
  • Phone: 304-550-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12183
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: