Provider Demographics
NPI:1326577990
Name:ROYAL LANE DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:ROYAL LANE DENTAL CENTER PLLC
Other - Org Name:ROYAL LANE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-904-2080
Mailing Address - Street 1:8499 GREENVILLE AVE
Mailing Address - Street 2:210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2413
Mailing Address - Country:US
Mailing Address - Phone:469-904-2080
Mailing Address - Fax:
Practice Address - Street 1:8499 GREENVILLE AVE STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2412
Practice Address - Country:US
Practice Address - Phone:614-530-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty