1356739528 NPI number — GARLAND ORAL SURGERY & DENTAL IMPLANT CENTER, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356739528 NPI number — GARLAND ORAL SURGERY & DENTAL IMPLANT CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARLAND ORAL SURGERY & DENTAL IMPLANT CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356739528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 BROADWAY BLVD
Provider Second Line Business Mailing Address:
STE. 201
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75041-3764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-271-6528
Provider Business Mailing Address Fax Number:
972-271-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2910 BROADWAY BLVD
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75041-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-271-6528
Provider Business Practice Location Address Fax Number:
972-271-6529
Provider Enumeration Date:
12/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-528-5500

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  19017 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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