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General NPI Number Information
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NPI Number | 1427057678
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Entity Type | Organization
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Legal Business Name | PARKWAY VISTA DENTAL PLLC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5072 W PLANO PKWY SUITE 250
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 972-818-1300
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Fax | 972-818-1301
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Provider Business Mailing Address
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Address Line | 5072 W PLANO PKWY SUITE 250
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 972-818-1300
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Fax | 972-818-1301
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHRYN L. MINTON
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Credential | DDS
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Telephone | 972-818-1300
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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 | 20179432
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License Number State | TX
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