Provider Demographics
NPI:1306384722
Name:PEACHTREE DENTAL
Entity Type:Organization
Organization Name:PEACHTREE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-302-1955
Mailing Address - Street 1:14688 STATE HWY 121
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-302-1955
Mailing Address - Fax:
Practice Address - Street 1:14688 STATE HWY 121
Practice Address - Street 2:SUITE 110
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-302-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty