Provider Demographics
NPI:1154855823
Name:PLANO ENDODONTICS, PC
Entity Type:Organization
Organization Name:PLANO ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-713-6644
Mailing Address - Street 1:5072 W PLANO PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4469
Mailing Address - Country:US
Mailing Address - Phone:972-713-6644
Mailing Address - Fax:972-713-6794
Practice Address - Street 1:5072 W PLANO PKWY STE 180
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4469
Practice Address - Country:US
Practice Address - Phone:972-713-6644
Practice Address - Fax:972-713-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty