Healthcare Provider Details

I. General information

NPI: 1861641995
Provider Name (Legal Business Name): PEPPERMINT DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 PRESIDENT GEORGE BUSH HWY STE 140
ROWLETT TX
75089-3694
US

IV. Provider business mailing address

PO BOX 734753
DALLAS TX
75373-4753
US

V. Phone/Fax

Practice location:
  • Phone: 214-703-0703
  • Fax:
Mailing address:
  • Phone: 214-703-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MARY PU
Title or Position: REGIONAL FINANCE OFFICER
Credential: PHARMD
Phone: 817-675-8753