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General NPI Number Information
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NPI Number | 1598918955
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Entity Type | Organization
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Legal Business Name | PACIFIC DENTAL CENTER LLC
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 3043 OLD DENTON RD 108
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City | CARROLLTON
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State | TX
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Zip | 75007-5036
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Country | US
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Telephone | 972-567-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 3043 OLD DENTON RD 108
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City | CARROLLTON
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State | TX
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Zip | 75007-5036
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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 | MEMBER
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Name | TUAN D SU
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Credential |
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Telephone | 972-567-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 020476
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License Number State | TX
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