Healthcare Provider Details

I. General information

NPI: 1508130063
Provider Name (Legal Business Name): ZOMAX INC, DBA: PRECIOUS DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S SHILOH RD STE 400
GARLAND TX
75042-8211
US

IV. Provider business mailing address

1919 S SHILOH RD STE 400
GARLAND TX
75042-8211
US

V. Phone/Fax

Practice location:
  • Phone: 469-326-0326
  • Fax: 469-326-0328
Mailing address:
  • Phone: 469-326-0326
  • Fax: 469-326-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRIS ENEMO
Title or Position: MANAGER
Credential:
Phone: 469-326-0326