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General NPI Number Information
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NPI Number | 1306400411
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Entity Type | Organization
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Legal Business Name | DENTAL DEPOT OF LITTLE ELM, PLLC
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 26747 E UNIVERSITY DR.
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City | AUBREY
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State | TX
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Zip | 76227
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Country | US
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Telephone | 972-884-0065
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Fax | 972-863-0499
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Provider Business Mailing Address
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Address Line | PO BOX 561205
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City | THE COLONY
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State | TX
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Zip | 75056
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Country | US
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Telephone | 972-703-2525
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Fax | 972-332-0141
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. HIMESH I KANA
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Credential | DDS
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Telephone | 729-758-8999
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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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