Provider Demographics
NPI:1275888935
Name:DIVINE DENTAL GROUP
Entity Type:Organization
Organization Name:DIVINE DENTAL GROUP
Other - Org Name:RUSH CREEK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SATER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-323-3299
Mailing Address - Street 1:6401 S COOPER ST
Mailing Address - Street 2:#105
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6751
Mailing Address - Country:US
Mailing Address - Phone:682-323-3299
Mailing Address - Fax:
Practice Address - Street 1:6401 S COOPER ST
Practice Address - Street 2:#105
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6751
Practice Address - Country:US
Practice Address - Phone:682-323-3299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty