Provider Demographics
NPI:1437419587
Name:PANACHE DENTAL, PLLC RASCHEDA D LONG SOLE MBR
Entity Type:Organization
Organization Name:PANACHE DENTAL, PLLC RASCHEDA D LONG SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RASCHEDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-383-9406
Mailing Address - Street 1:977 GARDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3742
Mailing Address - Country:US
Mailing Address - Phone:214-383-9406
Mailing Address - Fax:214-383-9480
Practice Address - Street 1:977 GARDEN PARK DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3742
Practice Address - Country:US
Practice Address - Phone:214-383-9406
Practice Address - Fax:214-383-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty