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General NPI Number Information
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NPI Number | 1043840069
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Entity Type | Organization
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Legal Business Name | THRIVE DENTAL ALLEN PLLC
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 1010 W EXCHANGE PKWY #130
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City | ALLEN
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State | TX
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Zip | 75013
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Country | US
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Telephone | 323-898-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 5822 VICKERY BLVD
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City | DALLAS
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State | TX
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Zip | 75206-6336
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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 | OWNER
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Name | DR. NATHAN COUGHLIN
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Credential | DDS
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Telephone | 323-898-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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