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General NPI Number Information
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NPI Number | 1700665601
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Entity Type | Organization
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Legal Business Name | DENTAL DELITE PG PA
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 8222 BRUTON RD
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City | DALLAS
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State | TX
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Zip | 75217-1902
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Country | US
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Telephone | 214-398-1234
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Fax | 866-610-0446
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Provider Business Mailing Address
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Address Line | PO BOX 172198
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City | DALLAS
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State | TX
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Zip | 75217-1108
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Country | US
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Telephone | 214-398-1234
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Fax | 866-610-0446
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DOMINIQUE VALLADAREZ
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Credential |
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Telephone | 214-398-1234
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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 |
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License Number State |
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