Provider Demographics
NPI:1285865493
Name:DENTAL EXPRESSIONS, P.C.
Entity Type:Organization
Organization Name:DENTAL EXPRESSIONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-951-9717
Mailing Address - Street 1:3330 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4728
Mailing Address - Country:US
Mailing Address - Phone:214-228-5094
Mailing Address - Fax:
Practice Address - Street 1:3330 N GALLOWAY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4756
Practice Address - Country:US
Practice Address - Phone:214-228-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty