Provider Demographics
NPI:1578151478
Name:PRINCETON PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:PRINCETON PEDIATRIC DENTISTRY PLLC
Other - Org Name:PEDIATRIC DENTISTRY OF PRINCETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:DANG
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-816-3819
Mailing Address - Street 1:275 W PRINCETON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-9712
Mailing Address - Country:US
Mailing Address - Phone:972-736-1000
Mailing Address - Fax:
Practice Address - Street 1:275 W PRINCETON DR STE 100
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9712
Practice Address - Country:US
Practice Address - Phone:609-816-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty