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General NPI Number Information
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NPI Number | 1730924259
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Entity Type | Organization
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Legal Business Name | MYRIAD DENTAL STUDIO PLLC
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 3000 FM 407 E STE 300
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City | BARTONVILLE
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State | TX
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Zip | 76226-9366
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Country | US
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Telephone | 719-466-3467
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 FM 407 E STE 300
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City | BARTONVILLE
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State | TX
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Zip | 76226-9366
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Country | US
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Telephone | 719-466-3467
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DIANA LOPEZ
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Credential | DDS
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Telephone | 940-226-2000
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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