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General NPI Number Information
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NPI Number | 1710244546
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Entity Type | Organization
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Legal Business Name | MESQUITE ENDODONTICS, PA
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 1534 E INTERSTATE 30 SUITE 200
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City | GARLAND
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State | TX
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Zip | 75043-4788
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Country | US
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Telephone | 972-270-4456
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Fax | 972-270-4042
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Provider Business Mailing Address
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Address Line | PO BOX 678074
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City | DALLAS
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State | TX
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Zip | 75267-8074
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Country | US
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Telephone | 972-270-4456
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Fax | 972-270-4042
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORI ANNA DEES
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Credential | DDS
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Telephone | 972-270-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 20068
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License Number State | TX
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