Provider Demographics
NPI:1437314101
Name:NORTH MESQUITE DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:NORTH MESQUITE DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-686-6477
Mailing Address - Street 1:5115 N GALLOWAY AVE
Mailing Address - Street 2:#301
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7526
Mailing Address - Country:US
Mailing Address - Phone:972-686-6477
Mailing Address - Fax:972-613-7504
Practice Address - Street 1:5115 N GALLOWAY AVE
Practice Address - Street 2:#301
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7526
Practice Address - Country:US
Practice Address - Phone:972-686-6477
Practice Address - Fax:972-613-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty