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General NPI Number Information
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NPI Number | 1720523186
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Entity Type | Organization
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Legal Business Name | CELEBRITY DENTAL & ORTHODONTICS PLLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 817 W JEFFERSON BLVD STE 2
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City | DALLAS
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State | TX
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Zip | 75208-4924
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Country | US
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Telephone | 469-930-8280
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Fax | 855-541-0586
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Provider Business Mailing Address
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Address Line | 10711 STRAIT LN
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City | DALLAS
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State | TX
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Zip | 75229-5428
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Country | US
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Telephone | 214-253-2402
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BECKY ESPINOZA
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Credential |
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Telephone | 817-785-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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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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