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General NPI Number Information
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NPI Number | 1457790933
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Entity Type | Organization
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Legal Business Name | PARK CITIES FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 3100 MONTICELLO AVE SUITE 110
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City | DALLAS
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State | TX
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Zip | 75205-3442
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Country | US
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Telephone | 214-528-3770
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Fax | 214-526-7436
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Provider Business Mailing Address
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Address Line | 3100 MONTICELLO AVE SUITE 110
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City | DALLAS
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State | TX
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Zip | 75205-3442
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Country | US
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Telephone | 214-528-3770
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Fax | 214-526-7436
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY W HUBBARD
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Credential | DDS
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Telephone | 214-528-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 15507
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License Number State | TX
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