Provider Demographics
NPI:1346751732
Name:ARCH DENTAL OF DEBBIE PA
Entity Type:Organization
Organization Name:ARCH DENTAL OF DEBBIE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-533-4755
Mailing Address - Street 1:4712 SEA HAWK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4147
Mailing Address - Country:US
Mailing Address - Phone:954-591-0298
Mailing Address - Fax:
Practice Address - Street 1:1450 DEBBIE LANE
Practice Address - Street 2:SUITE #130
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002
Practice Address - Country:US
Practice Address - Phone:817-533-4755
Practice Address - Fax:817-533-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty