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General NPI Number Information
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NPI Number | 1982147708
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Entity Type | Organization
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Legal Business Name | DENTSPAN PLLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 3680 SH 121 100
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City | PLANO
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State | TX
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Zip | 75025
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Country | US
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Telephone | 617-794-5879
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Fax |
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Provider Business Mailing Address
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Address Line | 3680 SH 121 100
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City | PLANO
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State | TX
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Zip | 75025
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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
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Name | RISHI BAFNA
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Credential | DMD
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Telephone | 617-794-5879
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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 | 31671
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License Number State | TX
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