MEDICARE: DPWP, P.L.L.C.

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	15768	TX

General Provider Information

NPI Number	:	1417265547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPWP, P.L.L.C.

Provider Business Mailing Address
First Line	:	1300 VILLAGE CREEK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4449
Country	:	US
Telephone Number	:	972-380-8105
Fax Number	:	972-380-0137

Provider Business Practice Location Address
First Line	:	1300 VILLAGE CREEK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4449
Country	:	US
Telephone Number	:	972-380-8105
Fax Number	:	972-380-0137

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSICA SEMPLE
Credential	:
Telephone Number	:	972-380-8105

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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