Provider Demographics
NPI:1033443742
Name:SHEPHERD LANE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SHEPHERD LANE DENTAL ASSOCIATES
Other - Org Name:TOWNGATE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:D.D.S./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-512-0285
Mailing Address - Street 1:15110 N. DALLAS PARKWAY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTHWEST HIGHWAY
Practice Address - Street 2:SUITE 112
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4851
Practice Address - Country:US
Practice Address - Phone:469-331-9460
Practice Address - Fax:469-331-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty