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General NPI Number Information
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NPI Number | 1386142602
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Entity Type | Organization
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Legal Business Name | EL DORADO DENTAL PLLC
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 4685 ELDORADO PKWY
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City | FRISCO
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State | TX
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Zip | 75033-0288
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Country | US
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Telephone | 214-396-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734753
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City | DALLAS
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State | TX
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Zip | 75373-4753
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Country | US
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Telephone | 214-396-3500
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Fax |
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Authorized Official
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Title or Position | PAYER ENROLLMENT MANAGER
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Name | JENNY ROCHA
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Credential |
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Telephone | 972-869-3789
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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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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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