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General NPI Number Information
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NPI Number | 1275972382
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Entity Type | Organization
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Legal Business Name | DENTACARE DENTAL OF COLLINS PA
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 2440 S COLLINS STREET SUITE #140
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City | ARLINGTON
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State | TX
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Zip | 76014
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Country | US
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Telephone | 817-459-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 S COLLINS STREET SUITE #140
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City | ARLINGTON
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State | TX
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Zip | 76014
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Country | US
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Telephone | 817-459-2501
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MS. ALEEAHNA PHAN
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Credential | DMD
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Telephone | 954-654-4694
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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 | 27164
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License Number State | TX
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