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General NPI Number Information
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NPI Number | 1215554555
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Entity Type | Organization
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Legal Business Name | ENSENADA DENTAL PLLC
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 311 S BOWEN RD
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City | ARLINGTON
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State | TX
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Zip | 76013-1255
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Country | US
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Telephone | 972-292-3092
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 E ELDORADO PKWY STE 100
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City | LITTLE ELM
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State | TX
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Zip | 75068-5502
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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 | DIRECTOR
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Name | MRS. MELISSA SIGMAN
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Credential |
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Telephone | 972-523-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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