Provider Demographics
NPI:1417014812
Name:DEEPAK, C. N. (MDS)
Entity Type:Individual
Prefix:
First Name:C. N.
Middle Name:
Last Name:DEEPAK
Suffix:
Gender:M
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6612
Mailing Address - Country:US
Mailing Address - Phone:817-540-2552
Mailing Address - Fax:
Practice Address - Street 1:5760 W PLEASANT RIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4482
Practice Address - Country:US
Practice Address - Phone:817-561-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics