Provider Demographics
NPI:1366628539
Name:PROGRESSIVE ENDODONTICS, P.A.
Entity Type:Organization
Organization Name:PROGRESSIVE ENDODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:214-528-4196
Mailing Address - Street 1:4514 COLE AVE
Mailing Address - Street 2:SUIRE 930
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5412
Mailing Address - Country:US
Mailing Address - Phone:214-528-4196
Mailing Address - Fax:214-528-2615
Practice Address - Street 1:4514 COLE AVE
Practice Address - Street 2:SUIRE 930
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5412
Practice Address - Country:US
Practice Address - Phone:214-528-4196
Practice Address - Fax:214-528-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty