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General NPI Number Information
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NPI Number | 1609383033
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Entity Type | Organization
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Legal Business Name | 6 DAY DENTAL GROUP - FLOWER MOUND, PLLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 6050 LONG PRAIRIE RD STE 100
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City | FLOWER MOUND
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State | TX
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Zip | 75028-5613
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Country | US
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Telephone | 972-316-6320
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Fax |
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Provider Business Mailing Address
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Address Line | 212 OLD GRANDE BLVD STE B224
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City | TYLER
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State | TX
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Zip | 75703-4277
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Country | US
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Telephone | 903-509-0505
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Fax | 903-707-2073
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | YOUNG SHIM
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Credential | DMD
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Telephone | 404-512-0760
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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 | 31033
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License Number State | TX
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