Provider Demographics
NPI:1114369238
Name:ACDENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:ACDENTAL CENTER, PLLC
Other - Org Name:AN ELEGANTE STAPLES DENTAL CARE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-816-2083
Mailing Address - Street 1:4117 S. STAPLES BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-850-8000
Mailing Address - Fax:361-850-8001
Practice Address - Street 1:4117 S. STAPLES BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-850-8000
Practice Address - Fax:361-850-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI04142017001987Medicare PIN