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General NPI Number Information
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NPI Number | 1609127356
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Entity Type | Organization
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Legal Business Name | CENTRE FOR DIAGNOSTIC AND COSMETIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 5501 INDEPENDENCE PKWY SUITE 107
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City | PLANO
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State | TX
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Zip | 75023-5463
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Country | US
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Telephone | 972-612-4498
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Fax | 972-612-4498
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Provider Business Mailing Address
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Address Line | 5501 INDEPENDENCE PKWY SUITE 107
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City | PLANO
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State | TX
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Zip | 75023-5463
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Country | US
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Telephone | 972-964-5928
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Fax | 972-612-4498
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Authorized Official
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Title or Position | OWNER
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Name | DR. REGINA DENISE POWE
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Credential | DDS
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Telephone | 972-612-9948
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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 | 16450
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License Number State | TX
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