MEDICARE: TEXAS PRIME DENTAL GROUP II 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1457973224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PRIME DENTAL GROUP II PC

Provider Business Mailing Address
First Line	:	14075 WATERFALL WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3841
Country	:	US
Telephone Number	:	972-783-5711
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	:	PARTNER
Name	:	DR. MILTON DANG
Credential	:	DDS
Telephone Number	:	972-783-5711

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	11/03/2020

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