Provider Demographics
NPI:1164275947
Name:CELINA DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:CELINA DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-662-3105
Mailing Address - Street 1:5000 LEGACY DR STE 240
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3112
Mailing Address - Country:US
Mailing Address - Phone:972-521-8387
Mailing Address - Fax:
Practice Address - Street 1:515 S. PRESTON RD
Practice Address - Street 2:STE 130
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009
Practice Address - Country:US
Practice Address - Phone:414-916-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty