Provider Demographics
NPI:1073520193
Name:NORTH TEXAS PERIODONTICS AND IMPLANTOLOGY, LLP
Entity Type:Organization
Organization Name:NORTH TEXAS PERIODONTICS AND IMPLANTOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-394-1234
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:STE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2484
Mailing Address - Country:US
Mailing Address - Phone:972-394-1234
Mailing Address - Fax:972-394-1154
Practice Address - Street 1:3730 N JOSEY LN
Practice Address - Street 2:STE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2484
Practice Address - Country:US
Practice Address - Phone:972-394-1234
Practice Address - Fax:972-394-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167261223P0300X
TX173651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty