Provider Demographics
NPI:1447749189
Name:LONE REPUBLIC DENTAL CORP
Entity Type:Organization
Organization Name:LONE REPUBLIC DENTAL CORP
Other - Org Name:FRISCO'S DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-827-8337
Mailing Address - Street 1:3535 VICTORY GROUP WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6720
Mailing Address - Country:US
Mailing Address - Phone:972-827-8337
Mailing Address - Fax:972-837-3730
Practice Address - Street 1:3535 VICTORY GROUP WAY STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6720
Practice Address - Country:US
Practice Address - Phone:972-827-8337
Practice Address - Fax:972-837-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty