Provider Demographics
NPI:1376969691
Name:TEXAS FAMILY DENTAL
Entity Type:Organization
Organization Name:TEXAS FAMILY DENTAL
Other - Org Name:AMERICAN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-340-4965
Mailing Address - Street 1:10233 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4407
Mailing Address - Country:US
Mailing Address - Phone:214-340-4965
Mailing Address - Fax:214-343-0154
Practice Address - Street 1:10233 E NORTHWEST HWY
Practice Address - Street 2:SUITE 510
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4407
Practice Address - Country:US
Practice Address - Phone:214-340-4965
Practice Address - Fax:214-343-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty