Provider Demographics
NPI:1417593302
Name:KATHRINA CARRASCO DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:KATHRINA CARRASCO DENTAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-551-9058
Mailing Address - Street 1:6513 PRESTON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2711
Mailing Address - Country:US
Mailing Address - Phone:972-378-6762
Mailing Address - Fax:972-378-6771
Practice Address - Street 1:6513 PRESTON RD STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2711
Practice Address - Country:US
Practice Address - Phone:972-378-6762
Practice Address - Fax:972-378-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty