Healthcare Provider Details

I. General information

NPI: 1821824764
Provider Name (Legal Business Name): OS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 N GALLOWAY AVE
MESQUITE TX
75150-4861
US

IV. Provider business mailing address

2856 N GALLOWAY AVE
MESQUITE TX
75150-4861
US

V. Phone/Fax

Practice location:
  • Phone: 972-698-8000
  • Fax:
Mailing address:
  • Phone: 972-698-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. OLGA STEPANCHENKO
Title or Position: DENTIST
Credential: DDS
Phone: 972-698-8000