Healthcare Provider Details

I. General information

NPI: 1346728896
Provider Name (Legal Business Name): AVANT DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 W MILLER RD
GARLAND TX
75041
US

IV. Provider business mailing address

843 W MILLER RD
GARLAND TX
75041-1811
US

V. Phone/Fax

Practice location:
  • Phone: 972-864-0222
  • Fax: 972-864-0200
Mailing address:
  • Phone: 972-864-0222
  • Fax: 972-864-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPHINE YIP
Title or Position: DENTIST
Credential: DDS
Phone: 972-864-0222