Provider Demographics
NPI:1073072369
Name:CAREWELL DENTAL DALLAS PA
Entity Type:Organization
Organization Name:CAREWELL DENTAL DALLAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-714-7997
Mailing Address - Street 1:3128 FOREST LN STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7725
Mailing Address - Country:US
Mailing Address - Phone:972-241-4820
Mailing Address - Fax:
Practice Address - Street 1:3128 FOREST LN STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7725
Practice Address - Country:US
Practice Address - Phone:972-241-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770747578OtherNPI
TX1962995134OtherNPI