Provider Demographics
NPI:1154862415
Name:CNC-DENTAL
Entity Type:Organization
Organization Name:CNC-DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-306-2121
Mailing Address - Street 1:4043 TRINITY MILLS RD
Mailing Address - Street 2:#101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6778
Mailing Address - Country:US
Mailing Address - Phone:972-306-2121
Mailing Address - Fax:
Practice Address - Street 1:4043 TRINITY MILLS RD
Practice Address - Street 2:#101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6778
Practice Address - Country:US
Practice Address - Phone:972-306-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22398261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental