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General NPI Number Information
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NPI Number | 1326577990
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Entity Type | Organization
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Legal Business Name | ROYAL LANE DENTAL CENTER PLLC
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 8499 GREENVILLE AVE STE 210
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City | DALLAS
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State | TX
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Zip | 75231-2412
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Country | US
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Telephone | 614-530-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 8499 GREENVILLE AVE 210
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City | DALLAS
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State | TX
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Zip | 75231-2413
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Country | US
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Telephone | 469-904-2080
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SANG PARK
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Credential | DDS
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Telephone | 469-904-2080
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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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