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General NPI Number Information
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NPI Number | 1427415116
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Entity Type | Organization
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Legal Business Name | DFW DENTAL TEAM
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 5744 LBJ FWY
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City | DALLAS
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State | TX
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Zip | 75240-6322
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Country | US
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Telephone | 713-481-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 5744 LBJ FWY
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City | DALLAS
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State | TX
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Zip | 75240-6322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KETAN SUKKAWALA
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Credential |
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Telephone | 979-450-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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