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General NPI Number Information
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NPI Number | 1396377594
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Entity Type | Organization
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Legal Business Name | FRESCA DENTAL PLLC
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 10121 LAKE JUNE RD STE 118
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City | DALLAS
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State | TX
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Zip | 75217-5345
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Country | US
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Telephone | 469-930-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 EMPIRE CENTRAL PL STE 112
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City | DALLAS
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State | TX
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Zip | 75247-4312
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Country | US
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Telephone | 480-747-5129
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RAHUL JOSHI
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Credential | DDS
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Telephone | 480-747-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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