1033553805 NPI number — MACARTHUR PARK DENTISTRY, PA

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 1033553805 NPI number — MACARTHUR PARK DENTISTRY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACARTHUR PARK DENTISTRY, PA
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:
1033553805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7447 N. MACARTHUR BLVD
Provider Second Line Business Mailing Address:
#185
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-831-9600
Provider Business Mailing Address Fax Number:
972-314-9691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7447 N. MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
#185
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-831-9600
Provider Business Practice Location Address Fax Number:
972-314-9691
Provider Enumeration Date:
04/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
HANNAH
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
972-931-9600

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  19720 , 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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