Provider Demographics
NPI:1558784546
Name:DENTON FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:DENTON FAMILY DENTAL CARE
Other - Org Name:VANILLA FAMILY DENTISTRY
Other - Org Type:Doing Business As
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:940-387-2273
Mailing Address - Street 1:3969 TEASLEY LN
Mailing Address - Street 2:STE 1500
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8401
Mailing Address - Country:US
Mailing Address - Phone:940-387-2273
Mailing Address - Fax:
Practice Address - Street 1:3969 TEASLEY LN
Practice Address - Street 2:STE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty