Healthcare Provider Details

I. General information

NPI: 1811151327
Provider Name (Legal Business Name): SHEPHERD LANE DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6959 ARAPAHO RD SUITE 551
DALLAS TX
75248-4022
US

IV. Provider business mailing address

3501 SHEPHERD LN
BALCH SPRINGS TX
75180-2325
US

V. Phone/Fax

Practice location:
  • Phone: 972-385-9331
  • Fax: 972-385-0741
Mailing address:
  • Phone: 972-286-5711
  • Fax: 972-286-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY J BLANEK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 972-385-9331