MEDICARE: DENSTAR DENTAL I PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366722621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENSTAR DENTAL I PA

Provider Business Mailing Address
First Line	:	14075 WATERFALL WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3841
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14075 WATERFALL WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3841
Country	:	US
Telephone Number	:	972-783-5711
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. TRINH CAO
Credential	:
Telephone Number	:	972-783-5711

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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Directions to “DENSTAR DENTAL I PA ” Practice Location

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