=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194529180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAASSEN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2025
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 W CAMPBELL RD STE 200
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-2981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-770-5159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2825 NEWBURYPORT AVE
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75044-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-770-5159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | PHILLIP CLAASSEN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 239-770-5159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------