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General NPI Number Information
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NPI Number | 1427494590
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES OF LAS COLINAS
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 3108 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75062-4451
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Country | US
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Telephone | 972-252-9557
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Fax | 972-257-8322
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Provider Business Mailing Address
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Address Line | 3108 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75062-4451
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Country | US
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Telephone | 972-252-9557
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Fax | 972-257-8322
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH JOSEPH
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Credential | DDS
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Telephone | 972-252-9557
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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 | 18939
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License Number State | TX
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Taxonomy #2
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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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