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General NPI Number Information
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NPI Number | 1942372461
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Entity Type | Organization
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Legal Business Name | PLANO CENTER FOR AESTHETIC DENTISTRY
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 AMERICAN DRIVE SUITE 201
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City | PLANO
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State | TX
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Zip | 75075
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Country | US
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Telephone | 972-644-5544
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Fax | 972-398-2788
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Provider Business Mailing Address
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Address Line | 3900 AMERICAN DRIVE SUITE 201
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City | PLANO
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State | TX
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Zip | 75075
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Country | US
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Telephone | 972-644-5544
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Fax | 972-398-2788
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARREN KEITH DICKSON
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Credential | DDS
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Telephone | 972-644-5544
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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 | TX19356
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License Number State | TX
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