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General NPI Number Information
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NPI Number | 1578383204
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Entity Type | Organization
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Legal Business Name | HIBISCUS DENTAL PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1614 E BELT LINE RD
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City | CARROLLTON
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State | TX
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Zip | 75006-6309
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Country | US
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Telephone | 972-245-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 137 CARRINGTON DR
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City | COPPELL
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State | TX
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Zip | 75019-6263
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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 | DDS
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Name | CHUN-SUEN LEE
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Credential |
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Telephone | 972-352-1504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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