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General NPI Number Information
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NPI Number | 1811668643
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Entity Type | Organization
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Legal Business Name | DFW STADIUM DENTAL PC
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1514 E ABRAM ST STE A
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City | ARLINGTON
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State | TX
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Zip | 76010-7259
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Country | US
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Telephone | 682-323-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 E ABRAM ST STE A
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City | ARLINGTON
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State | TX
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Zip | 76010-7259
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Country | US
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Telephone | 682-323-5522
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Fax |
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. BEN LUKA
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Credential |
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Telephone | 682-323-5522
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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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