Provider Demographics
NPI:1114513256
Name:CHARISMA DENTAL
Entity Type:Organization
Organization Name:CHARISMA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-501-2640
Mailing Address - Street 1:1735 KELLER SPRINGS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3014
Mailing Address - Country:US
Mailing Address - Phone:469-501-2660
Mailing Address - Fax:
Practice Address - Street 1:1735 KELLER SPRINGS RD STE 212
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3014
Practice Address - Country:US
Practice Address - Phone:469-501-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992203376OtherNPI