Provider Demographics
NPI:1093832693
Name:ELDORADO FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:ELDORADO FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:KAMALESH
Authorized Official - Last Name:VINAYAGAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-705-7272
Mailing Address - Street 1:2405 FM 423 STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6666
Mailing Address - Country:US
Mailing Address - Phone:214-705-7272
Mailing Address - Fax:214-705-7892
Practice Address - Street 1:2405 FM 423 STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6666
Practice Address - Country:US
Practice Address - Phone:214-705-7272
Practice Address - Fax:214-705-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty