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General NPI Number Information
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NPI Number | 1275904641
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Entity Type | Organization
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Legal Business Name | DESOTO DENTAL PLLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 116 W PARKERVILLE RD STE # 112
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City | DESOTO
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State | TX
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Zip | 75115
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Country | US
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Telephone | 972-750-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 PARKWOOD BLVD #310
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City | PLANO
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State | TX
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Zip | 75093-8750
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Country | US
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Telephone | 972-750-0610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHESH BABU GONDI
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Credential | D.M.D.
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Telephone | 972-750-0610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22213
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License Number State | TX
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