Provider Demographics
NPI:1326333675
Name:DALLAS DENTAL CARELLC
Entity Type:Organization
Organization Name:DALLAS DENTAL CARELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-725-4545
Mailing Address - Street 1:471 PIONEER RD
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813
Mailing Address - Country:US
Mailing Address - Phone:229-725-4545
Mailing Address - Fax:229-725-4469
Practice Address - Street 1:471 PIONEER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813
Practice Address - Country:US
Practice Address - Phone:229-725-4545
Practice Address - Fax:229-725-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty