Provider Demographics
NPI:1043531841
Name:EXCEL DENTAL CLINIC OF LANCASTER, PC
Entity Type:Organization
Organization Name:EXCEL DENTAL CLINIC OF LANCASTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:TU
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-655-9941
Mailing Address - Street 1:4709 RAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3838
Mailing Address - Country:US
Mailing Address - Phone:469-655-5221
Mailing Address - Fax:214-375-9997
Practice Address - Street 1:3200 S LANCASTER RD STE 183
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4555
Practice Address - Country:US
Practice Address - Phone:214-375-9999
Practice Address - Fax:214-375-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24546122300000X
122300000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212165901Medicaid