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General NPI Number Information
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NPI Number | 1831623347
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Entity Type | Organization
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Legal Business Name | OAK RIDGE DENTAL PLLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 2334 W BUCKINGHAM RD SUITE 260
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City | GARLAND
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State | TX
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Zip | 75042-4934
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Country | US
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Telephone | 469-288-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 PECAN MEADOW DR
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City | GARLAND
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State | TX
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Zip | 75040-3983
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Country | US
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Telephone |
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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 | PHONG LAN NGUYEN
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Credential |
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Telephone | 469-288-9301
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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 | 25494
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License Number State | TX
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