Provider Demographics
NPI:1114625522
Name:FMDTX,PLLC
Entity Type:Organization
Organization Name:FMDTX,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-292-9088
Mailing Address - Street 1:7151 PRESTON RD STE 431D
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5859
Mailing Address - Country:US
Mailing Address - Phone:972-292-9088
Mailing Address - Fax:972-292-9884
Practice Address - Street 1:7151 PRESTON RD STE 431D
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5859
Practice Address - Country:US
Practice Address - Phone:972-292-9088
Practice Address - Fax:972-292-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX447833101Medicaid