Healthcare Provider Details

I. General information

NPI: 1972363729
Provider Name (Legal Business Name): TRIBUTE FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 FM 423 STE 600
FRISCO TX
75036-8962
US

IV. Provider business mailing address

4713 HIGHWAY 121 STE 304
THE COLONY TX
75056-2901
US

V. Phone/Fax

Practice location:
  • Phone: 469-598-1021
  • Fax: 469-598-1031
Mailing address:
  • Phone: 972-538-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN BAHARVAND
Title or Position: OWNER
Credential: DMD
Phone: 617-699-2519