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NPI Code Detail

MEDICARE: DENTAL REPUBLIC - BUCKNER, PC

MEDICARE: DENTAL REPUBLIC - BUCKNER, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1154547057
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL REPUBLIC - BUCKNER, PC
Provider Business Mailing Address
First Line : 508 W MCDERMOTT DR
Second Line : STE 100
City : ALLEN
State : TX
Zip : 75013-2777
Country : US
Telephone Number : 972-747-1400
Fax Number :
Provider Business Practice Location Address
First Line : 2336 S BUCKNER BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75227-8605
Country : US
Telephone Number : 214-381-2020
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. SON TRAN
Credential : D.D.S.
Telephone Number : 972-747-1400
Provider Enumeration Date : 04/18/2007
Last Update Date : 04/19/2011

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Directions to “DENTAL REPUBLIC - BUCKNER, PC ” Practice Location

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