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General NPI Number Information
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NPI Number | 1295587780
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Entity Type | Organization
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Legal Business Name | TK DENTAL PLLC
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 1101 W CENTERVILLE RD STE 200
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City | GARLAND
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State | TX
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Zip | 75041-5917
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Country | US
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Telephone | 469-309-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 HUNTERSRIDGE DR
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City | IRVING
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State | TX
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Zip | 75063-5697
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Country | US
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Telephone | 469-309-1670
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | OMAR LARA
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Credential |
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Telephone | 469-309-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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