Healthcare Provider Details

I. General information

NPI: 1740501501
Provider Name (Legal Business Name): DONTIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 OHIO DR SUITE #107
PLANO TX
75024-2357
US

IV. Provider business mailing address

8201 OHIO DR SUITE #107
PLANO TX
75024-2357
US

V. Phone/Fax

Practice location:
  • Phone: 214-387-8400
  • Fax: 214-299-8639
Mailing address:
  • Phone: 214-387-8400
  • Fax: 214-299-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24470
License Number StateTX

VIII. Authorized Official

Name: DR. SHALINI R THASMA
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 412-327-9669