Provider Demographics
NPI:1558708743
Name:DENTON FAMILY DENTAL CARE PLLC
Entity Type:Organization
Organization Name:DENTON FAMILY DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:LAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-991-1926
Mailing Address - Street 1:2411 S INTERSTATE 35 E
Mailing Address - Street 2:APT 1121
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4987
Mailing Address - Country:US
Mailing Address - Phone:360-991-1926
Mailing Address - Fax:
Practice Address - Street 1:3969 TEASLEY LN
Practice Address - Street 2:SUITE 1500
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8401
Practice Address - Country:US
Practice Address - Phone:940-387-2273
Practice Address - Fax:940-387-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24227261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental