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General NPI Number Information
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NPI Number | 1992323257
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Entity Type | Organization
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Legal Business Name | DUNCANVILLE DENTAL PLLC
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 5409 N JIM MILLER RD STE 105
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City | DALLAS
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State | TX
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Zip | 75227-1500
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Country | US
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Telephone | 214-865-8319
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Fax |
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Provider Business Mailing Address
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Address Line | 6524 PRAIRIE FLOWER TRL
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City | DALLAS
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State | TX
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Zip | 75227-2803
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Country | US
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Telephone | 214-298-4656
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CECILIA SIMMONS
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Credential | DDS
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Telephone | 214-865-8319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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