Provider Demographics
NPI:1225405467
Name:PRIDENT DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PRIDENT DENTAL ASSOCIATES, P.C.
Other - Org Name:TYLER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-362-2225
Mailing Address - Street 1:15110 DALLAS PKWY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 S TYLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6254
Practice Address - Country:US
Practice Address - Phone:972-632-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty