Healthcare Provider Details

I. General information

NPI: 1447370374
Provider Name (Legal Business Name): JANET EILEEN PRICE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET EILEEN STUKALIN D.D.S.

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 FOREST LN STE 318
DALLAS TX
75230-2776
US

IV. Provider business mailing address

5925 FOREST LN STE 318
DALLAS TX
75230-2776
US

V. Phone/Fax

Practice location:
  • Phone: 972-490-4881
  • Fax: 972-490-1270
Mailing address:
  • Phone: 972-490-4881
  • Fax: 972-490-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15816
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: