Provider Demographics
NPI:1477837821
Name:EXQUISITE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:EXQUISITE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTNUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-381-1272
Mailing Address - Street 1:5409 N JIM MILLER RD
Mailing Address - Street 2:105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1542
Mailing Address - Country:US
Mailing Address - Phone:214-381-1272
Mailing Address - Fax:214-381-6131
Practice Address - Street 1:5409 N JIM MILLER RD
Practice Address - Street 2:105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1542
Practice Address - Country:US
Practice Address - Phone:214-381-1272
Practice Address - Fax:214-381-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20923305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service