MEDICARE: DYNASTY DENTAL

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	20556	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1336425651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNASTY DENTAL

Provider Business Mailing Address
First Line	:	717 S GREENVILLE AVE
Second Line	:	#114
City	:	ALLEN
State	:	TX
Zip	:	75002-3317
Country	:	US
Telephone Number	:	214-547-8628
Fax Number	:	214-547-8675

Provider Business Practice Location Address
First Line	:	717 S GREENVILLE AVE
Second Line	:	#114
City	:	ALLEN
State	:	TX
Zip	:	75002-3317
Country	:	US
Telephone Number	:	214-547-8628
Fax Number	:	214-547-8675

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANET DIEM TRAN
Credential	:	DDS
Telephone Number	:	214-547-8628

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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Directions to “DYNASTY DENTAL ” Practice Location

Language	Start Address	Practice Location

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