Provider Demographics
NPI:1508311986
Name:SUREPOINT DENTAL PROFESSIONAL GRAND PRAIRIE PLLC
Entity Type:Organization
Organization Name:SUREPOINT DENTAL PROFESSIONAL GRAND PRAIRIE PLLC
Other - Org Name:CARRIER FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-259-2484
Mailing Address - Street 1:5005 LBJ FWY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6100
Mailing Address - Country:US
Mailing Address - Phone:214-259-2484
Mailing Address - Fax:
Practice Address - Street 1:355 E WESTCHESTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2847
Practice Address - Country:US
Practice Address - Phone:972-619-9108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty