MEDICARE: P LYNETTE PAGE DDS DENTAL MANAGEMENT LLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1316538150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P LYNETTE PAGE DDS DENTAL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	13601 PRESTON RD STE 350E
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4905
Country	:	US
Telephone Number	:	972-239-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	13601 PRESTON RD STE 350E
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4905
Country	:	US
Telephone Number	:	972-239-1962
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MR. ANTHONY VECCHIONE
Credential	:
Telephone Number	:	972-239-1962

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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