Provider Demographics
NPI:1467798835
Name:PLANO DENTAL LOFT PLLC
Entity Type:Organization
Organization Name:PLANO DENTAL LOFT PLLC
Other - Org Name:PLANO DENTAL LOFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-269-6190
Mailing Address - Street 1:3920 MCDERMOTT RD
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4420
Mailing Address - Country:US
Mailing Address - Phone:469-269-6190
Mailing Address - Fax:469-277-3149
Practice Address - Street 1:3920 MCDERMOTT RD
Practice Address - Street 2:STE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4420
Practice Address - Country:US
Practice Address - Phone:469-269-6190
Practice Address - Fax:469-277-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty