Provider Demographics
NPI:1497016463
Name:ARK DENTAL, P.C.
Entity Type:Organization
Organization Name:ARK DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-320-9444
Mailing Address - Street 1:9777 FERGUSON RD
Mailing Address - Street 2:101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3838
Mailing Address - Country:US
Mailing Address - Phone:214-320-9444
Mailing Address - Fax:214-320-9555
Practice Address - Street 1:9777 FERGUSON RD
Practice Address - Street 2:101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3838
Practice Address - Country:US
Practice Address - Phone:214-320-9444
Practice Address - Fax:214-320-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB18012-2OtherCHIP
TX145820001Medicaid
TX145819201Medicaid