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General NPI Number Information
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NPI Number | 1073520193
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS PERIODONTICS AND IMPLANTOLOGY, LLP
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3730 N JOSEY LN STE 110
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City | CARROLLTON
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State | TX
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Zip | 75007-2484
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Country | US
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Telephone | 972-394-1234
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Fax | 972-394-1154
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Provider Business Mailing Address
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Address Line | 3730 N JOSEY LN STE 110
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City | CARROLLTON
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State | TX
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Zip | 75007-2484
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Country | US
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Telephone | 972-394-1234
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Fax | 972-394-1154
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Authorized Official
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Title or Position | OWNER/MANAGING PARTNER
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Name | DR. MICHAEL J MCQUADE
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Credential | DDS, MS
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Telephone | 972-394-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 17365
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 16726
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License Number State | TX
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