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General NPI Number Information
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NPI Number | 1346620853
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Entity Type | Organization
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Legal Business Name | P LYNETTE PAGE DDS DENTAL MANAGEMENT LLC
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 6500 GREENVILLE AVE SUITE 100
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City | DALLAS
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State | TX
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Zip | 75206-1014
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Country | US
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Telephone | 214-692-7499
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Fax | 214-361-4145
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Provider Business Mailing Address
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Address Line | 6500 GREENVILLE AVE SUITE 100
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City | DALLAS
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State | TX
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Zip | 75206-1014
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Country | US
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Telephone | 214-692-7499
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Fax | 214-361-4145
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | ANTHONY VECCHIONE
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Credential |
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Telephone | 214-692-7499
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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 | 24175
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License Number State | TX
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