Provider Demographics
NPI:1407202229
Name:PRESTON DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PRESTON DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-233-9399
Mailing Address - Street 1:17194 PRESTON RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD
Practice Address - Street 2:SUITE 224
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1221
Practice Address - Country:US
Practice Address - Phone:972-233-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty