Provider Demographics
NPI:1508895418
Name:TEXAS DENTAL, P.A.
Entity Type:Organization
Organization Name:TEXAS DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CO-OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAZARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-381-1888
Mailing Address - Street 1:5132 VILLAGE CREEK DR
Mailing Address - Street 2:STE.400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5064
Mailing Address - Country:US
Mailing Address - Phone:972-381-1888
Mailing Address - Fax:972-381-7003
Practice Address - Street 1:5132 VILLAGE CREEK DR
Practice Address - Street 2:STE.400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5064
Practice Address - Country:US
Practice Address - Phone:972-381-1888
Practice Address - Fax:972-381-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188731223G0001X
TX185881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty