Provider Demographics
NPI:1407479389
Name:TEXAS PRIME DENTAL GROUP PC
Entity Type:Organization
Organization Name:TEXAS PRIME DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AN
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-244-6157
Mailing Address - Street 1:2221 LORING DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5840
Mailing Address - Country:US
Mailing Address - Phone:832-244-6157
Mailing Address - Fax:972-848-0281
Practice Address - Street 1:4637 HEDGCOXE RD STE 112
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3963
Practice Address - Country:US
Practice Address - Phone:972-377-8866
Practice Address - Fax:972-649-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty