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General NPI Number Information
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NPI Number | 1275821647
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Entity Type | Organization
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Legal Business Name | CELEBRITY DENTAL PC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 4808 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75227-2348
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Country | US
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Telephone | 214-388-4808
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Fax | 214-388-4100
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Provider Business Mailing Address
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Address Line | 4808 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75227-2348
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Country | US
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Telephone | 214-388-4808
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Fax | 214-388-4100
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Authorized Official
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Title or Position | OWNER
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Name | MARIA ELBA GARCIA-IBANCOVICHI
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Credential | D.D.S.
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Telephone | 214-388-4808
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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 | 16354
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License Number State | TX
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