Provider Demographics
NPI:1407612880
Name:CHILDREN'S DENTAL AT PRESTON TRAIL, PC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL AT PRESTON TRAIL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIREC OD CRED AND PROV RELA
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-638-0303
Mailing Address - Street 1:1610 54TH AVE N STE 205
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1442
Mailing Address - Country:US
Mailing Address - Phone:615-678-0759
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1264
Practice Address - Country:US
Practice Address - Phone:214-453-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S DENTAL AT PRESTON TRAIL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty