Provider Demographics
NPI:1326603697
Name:DRAGONFLY CURB SIDE DENTAL
Entity Type:Organization
Organization Name:DRAGONFLY CURB SIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-674-2635
Mailing Address - Street 1:2775 VILLA CREEK DR STE B-272
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7432
Mailing Address - Country:US
Mailing Address - Phone:214-674-2635
Mailing Address - Fax:469-283-2931
Practice Address - Street 1:2775 VILLA CREEK DR STE B-272
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7432
Practice Address - Country:US
Practice Address - Phone:214-674-2635
Practice Address - Fax:469-283-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM-24472OtherTEXAS DENTAL BOARD