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NPI Code Detail

MEDICARE: CELEBRITY DENTAL PC

MEDICARE: CELEBRITY DENTAL 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
1122300000XDentist16354TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275821647
Entity Type Code : Organization
Provider Name (Legal Business Name) : CELEBRITY DENTAL PC
Provider Business Mailing Address
First Line : 4808 S BUCKNER BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75227-2348
Country : US
Telephone Number : 214-388-4808
Fax Number : 214-388-4100
Provider Business Practice Location Address
First Line : 4808 S BUCKNER BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75227-2348
Country : US
Telephone Number : 214-388-4808
Fax Number : 214-388-4100
Authorized Official
Title or Position : OWNER
Name : MARIA ELBA GARCIA-IBANCOVICHI
Credential : D.D.S.
Telephone Number : 214-388-4808
Provider Enumeration Date : 07/19/2011
Last Update Date : 07/19/2011

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Directions to “CELEBRITY DENTAL PC ” Practice Location

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