Provider Demographics
NPI:1033436811
Name:IRVING - DR LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:IRVING - DR LIMITED LIABILITY COMPANY
Other - Org Name:DENTAL REPUBLIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-747-1400
Mailing Address - Street 1:2476 WORTHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2503
Mailing Address - Country:US
Mailing Address - Phone:972-747-1400
Mailing Address - Fax:
Practice Address - Street 1:1015 E IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-4350
Practice Address - Country:US
Practice Address - Phone:972-747-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty