Provider Demographics
NPI:1376791327
Name:TOWN EAST DENTAL
Entity Type:Organization
Organization Name:TOWN EAST DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTNUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-226-5582
Mailing Address - Street 1:5115 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7526
Mailing Address - Country:US
Mailing Address - Phone:972-226-5582
Mailing Address - Fax:972-226-6283
Practice Address - Street 1:5115 N GALLOWAY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7526
Practice Address - Country:US
Practice Address - Phone:972-226-5582
Practice Address - Fax:972-226-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty