Provider Demographics
NPI:1104379106
Name:ALLHEART DENTAL GRAND PRAIRIE,PLLC
Entity Type:Organization
Organization Name:ALLHEART DENTAL GRAND PRAIRIE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-577-1535
Mailing Address - Street 1:4125 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1144
Mailing Address - Country:US
Mailing Address - Phone:646-577-1535
Mailing Address - Fax:
Practice Address - Street 1:2502 S BELT LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5345
Practice Address - Country:US
Practice Address - Phone:646-577-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty