Provider Demographics
NPI:1134463961
Name:DALLAS EMERGENCY DENTAL
Entity Type:Organization
Organization Name:DALLAS EMERGENCY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-219-1159
Mailing Address - Street 1:3109 KNOX ST. BOX 311
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:214-219-1159
Mailing Address - Fax:972-576-3664
Practice Address - Street 1:3001 KNOX STE. # 300 B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:214-219-1159
Practice Address - Fax:972-576-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty