=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437896750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRODUCTIVE IMPRESSIONS DENTAL,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 05/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4940 W UNIVERSITY DR STE 40
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-9912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-733-2107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3728 BUCHANAN ST
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-733-2107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. DORIAN C. PRICE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 214-733-2107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------