Provider Demographics
NPI:1205387909
Name:GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS, PLLC
Entity Type:Organization
Organization Name:GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS, PLLC
Other - Org Name:GREAT EXPRESSIONS DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-403-1100
Mailing Address - Street 1:29777 TELEGRAPH RD
Mailing Address - Street 2:STE. 3000
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1303
Mailing Address - Country:US
Mailing Address - Phone:248-403-1100
Mailing Address - Fax:
Practice Address - Street 1:1551 HIGHWAY 287 N
Practice Address - Street 2:STE. 411
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8890
Practice Address - Country:US
Practice Address - Phone:248-203-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty