Provider Demographics
NPI:1518334705
Name:EMERGENCY DENTIST,LLC
Entity Type:Organization
Organization Name:EMERGENCY DENTIST,LLC
Other - Org Name:24 HOUR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-523-0455
Mailing Address - Street 1:5800 N I 35 STE 205
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-1438
Mailing Address - Country:US
Mailing Address - Phone:940-220-7833
Mailing Address - Fax:317-672-7524
Practice Address - Street 1:7225 US 31 S
Practice Address - Street 2:G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8685
Practice Address - Country:US
Practice Address - Phone:317-672-7582
Practice Address - Fax:317-672-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009586A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty