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General NPI Number Information
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NPI Number | 1780787994
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Entity Type | Organization
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Legal Business Name | AMERICAN HERITAGE DENTAL PA
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 10233 E NWHY 510
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City | DALLAS
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State | TX
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Zip | 75238
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Country | US
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Telephone | 214-340-4965
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Fax | 214-343-0154
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Provider Business Mailing Address
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Address Line | 10233 E NWHY 510
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City | DALLAS
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State | TX
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Zip | 75238
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Country | US
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Telephone | 214-340-4965
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Fax | 214-343-0154
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Authorized Official
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Title or Position | CEO
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Name | CARY ALAN SHATTO
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Credential | DDS
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Telephone | 214-340-4965
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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 | 16995
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License Number State | TX
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