Provider Demographics
NPI:1306400411
Name:DENTAL DEPOT OF LITTLE ELM, PLLC
Entity Type:Organization
Organization Name:DENTAL DEPOT OF LITTLE ELM, PLLC
Other - Org Name:DENTAL DEPOT OF LITTLE ELM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:HIMESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:KANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:729-758-8999
Mailing Address - Street 1:PO BOX 561205
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056
Mailing Address - Country:US
Mailing Address - Phone:972-703-2525
Mailing Address - Fax:972-332-0141
Practice Address - Street 1:26747 E UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:972-884-0065
Practice Address - Fax:972-863-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336233022OtherNPI
TX1548381536OtherNPI
TX1982736864OtherNPI