Provider Demographics
NPI:1508359696
Name:ENAMEL ONE DENTAL PLLC
Entity Type:Organization
Organization Name:ENAMEL ONE DENTAL PLLC
Other - Org Name:GALAXY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:DOMENICO
Authorized Official - Last Name:PERLASCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-971-2568
Mailing Address - Street 1:9540 GARLAND RD STE
Mailing Address - Street 2:STE 381 - #313
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3471
Mailing Address - Country:US
Mailing Address - Phone:214-971-2568
Mailing Address - Fax:
Practice Address - Street 1:5561 ALAMEDA AVE STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2915
Practice Address - Country:US
Practice Address - Phone:214-971-2568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760701833OtherNPPES