1467637231 NPI number — EXCEL DENTAL CLINIC OF DALLAS, PC

Table of content: (NPI 1467637231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467637231 NPI number — EXCEL DENTAL CLINIC OF DALLAS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL DENTAL CLINIC OF DALLAS, PC
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:
6
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:
1467637231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4709 RAVENDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-231-6382
Provider Business Mailing Address Fax Number:
972-271-4511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5459 LA SIERRA DR STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-363-7219
Provider Business Practice Location Address Fax Number:
214-363-2054
Provider Enumeration Date:
12/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUYNH
Authorized Official First Name:
CHI
Authorized Official Middle Name:
HUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-231-6382

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com