Provider Demographics
NPI:1164880977
Name:MCKINNEY ORTHODONTIC ARTS
Entity Type:Organization
Organization Name:MCKINNEY ORTHODONTIC ARTS
Other - Org Name:ORTHODONTEX MCKINNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:214-585-4500
Mailing Address - Street 1:1780 W VIRGINIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7864
Mailing Address - Country:US
Mailing Address - Phone:214-585-4500
Mailing Address - Fax:214-585-4510
Practice Address - Street 1:1780 W VIRGINIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7864
Practice Address - Country:US
Practice Address - Phone:214-585-4500
Practice Address - Fax:214-585-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty