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General NPI Number Information
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NPI Number | 1528122637
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Entity Type | Organization
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Legal Business Name | TRIDENT DENTAL INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1919 S SHILOH RD STE 225
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City | GARLAND
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State | TX
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Zip | 75042
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Country | US
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Telephone | 972-271-3009
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Fax | 972-271-6009
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Provider Business Mailing Address
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Address Line | 1919 S SHILOH RD STE 225
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City | GARLAND
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State | TX
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Zip | 75042
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Country | US
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Telephone | 972-271-3009
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Fax | 972-271-6009
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIM T NGO
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Credential | DDS
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Telephone | 972-271-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | TX16985
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License Number State | TX
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