Provider Demographics
NPI:1033511928
Name:ABC DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:ABC DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-300-6663
Mailing Address - Street 1:2548 LILLIAN MILLER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7212
Mailing Address - Country:US
Mailing Address - Phone:940-300-6663
Mailing Address - Fax:
Practice Address - Street 1:2548 LILLIAN MILLER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:940-300-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty