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General NPI Number Information
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NPI Number | 1043712037
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF TEXAS, P.A.
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 5044 TENNYSON PKWY STE A
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City | PLANO
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State | TX
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Zip | 75024-2953
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Country | US
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Telephone | 972-378-3601
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Fax |
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Provider Business Mailing Address
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Address Line | 5044 TENNYSON PKWY STE A
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City | PLANO
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State | TX
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Zip | 75024-2953
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING TEAM LEAD
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Name | CASSANDRA PETERSEN
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Credential |
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Telephone | 217-540-8972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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