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General NPI Number Information
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NPI Number | 1619276185
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Entity Type | Organization
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Legal Business Name | OAK CLIFF CHILDRENS DENTIST PLLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 400 N ZANG BLVD STE 100
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City | DALLAS
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State | TX
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Zip | 75208-4447
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Country | US
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Telephone | 214-390-9960
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Fax | 214-390-9961
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Provider Business Mailing Address
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Address Line | 400 N ZANG BLVD STE 100
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City | DALLAS
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State | TX
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Zip | 75208-4447
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Country | US
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Telephone | 214-390-9960
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SUNEETHA BOPPANA
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Credential | D.D.S.
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Telephone | 214-390-9960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22791
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License Number State | TX
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