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General NPI Number Information
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NPI Number | 1093058471
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL OF MCKINNEY
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 1321 N. TENNESSEE ST. STE.108
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City | MCKINNEY
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State | TX
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Zip | 75069
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Country | US
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Telephone | 469-742-0793
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Fax | 469-742-9937
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Provider Business Mailing Address
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Address Line | 1321 N TENNESSEE ST STE.108
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City | MCKINNEY
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State | TX
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Zip | 75069-2142
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Country | US
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Telephone | 469-742-0793
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Fax | 469-742-9937
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Authorized Official
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Title or Position | OWENER
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Name | DR. IRENE THAMMASITHIBOON
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Credential | DDS.
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Telephone | 469-742-0793
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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 | 25969
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License Number State | TX
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