Healthcare Provider Details

I. General information

NPI: 1124209556
Provider Name (Legal Business Name): TOWN CENTER DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 LAVON DR STE 370
GARLAND TX
75040-2974
US

IV. Provider business mailing address

4430 LAVON DR STE 370
GARLAND TX
75040-2974
US

V. Phone/Fax

Practice location:
  • Phone: 972-530-5200
  • Fax:
Mailing address:
  • Phone: 972-530-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21427
License Number StateTX

VIII. Authorized Official

Name: DR. TERESA H KNOTT
Title or Position: OWNER
Credential: DDS
Phone: 972-530-5200