Provider Demographics
NPI:1225401383
Name:ONE DENTAL GROUP,PLLC
Entity Type:Organization
Organization Name:ONE DENTAL GROUP,PLLC
Other - Org Name:MACK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-569-2368
Mailing Address - Street 1:1607 E MCKINNEY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-4595
Mailing Address - Country:US
Mailing Address - Phone:469-569-2368
Mailing Address - Fax:
Practice Address - Street 1:1607 E MCKINNEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-4595
Practice Address - Country:US
Practice Address - Phone:469-569-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty