Provider Demographics
NPI: | 1356469993 |
---|---|
Name: | PLANO-DBE, LTD |
Entity Type: | Organization |
Organization Name: | PLANO-DBE, LTD |
Other - Org Name: | PLANO ENDODONTICS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | MGR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARNETTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-713-6644 |
Mailing Address - Street 1: | 5072 W PLANO PKWY STE 180 |
Mailing Address - Street 2: | |
Mailing Address - City: | PLANO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75093-4469 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-713-6644 |
Mailing Address - Fax: | 972-713-6688 |
Practice Address - Street 1: | 5072 W PLANO PKWY STE 180 |
Practice Address - Street 2: | |
Practice Address - City: | PLANO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75093-4469 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-713-6644 |
Practice Address - Fax: | 972-713-6688 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-26 |
Last Update Date: | 2007-07-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 19698 | 1223E0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223E0200X | Dental Providers | Dentist | Endodontics | Group - Single Specialty |