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General NPI Number Information
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NPI Number | 1144748153
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL AT PRESTON TRAIL, PC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 17194 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75248-1221
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Country | US
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Telephone | 615-247-7100
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Fax | 615-247-7052
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Provider Business Mailing Address
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Address Line | 17194 PRESTON RD STE 160
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City | DALLAS
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State | TX
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Zip | 75248-1264
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Country | US
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Telephone | 214-453-2565
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Fax | 866-407-9977
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING AND PR
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Name | CHARLOTTE V DASCH
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Credential | DDS
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Telephone | 504-638-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7907
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License Number State | TN
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Taxonomy #2
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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 #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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