Provider Demographics
NPI:1033858006
Name:DENTAL REPUBLIC PLAZA PC
Entity Type:Organization
Organization Name:DENTAL REPUBLIC PLAZA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
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 1:3211 W NORTHWEST HWY # 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5944
Mailing Address - Country:US
Mailing Address - Phone:972-747-1400
Mailing Address - Fax:214-242-4455
Practice Address - Street 1:11535 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1343
Practice Address - Country:US
Practice Address - Phone:210-780-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-30
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental