Provider Demographics
NPI:1326472887
Name:FRESH DENTAL AND ORTHODONTICS
Entity Type:Organization
Organization Name:FRESH DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KIEU-TRINH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:232-232-5062
Mailing Address - Street 1:1921 PRESTON RD # 2010
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5102
Mailing Address - Country:US
Mailing Address - Phone:972-250-0048
Mailing Address - Fax:972-250-0050
Practice Address - Street 1:1921 PRESTON RD # 2010
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5102
Practice Address - Country:US
Practice Address - Phone:972-250-0048
Practice Address - Fax:972-250-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty