Provider Demographics
NPI:1578251930
Name:EMERGIDENT PLLC
Entity Type:Organization
Organization Name:EMERGIDENT PLLC
Other - Org Name:REVIVE COSMETIC DENTISTRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-914-0003
Mailing Address - Street 1:670 W ARAPAHO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4213
Mailing Address - Country:US
Mailing Address - Phone:469-914-0003
Mailing Address - Fax:800-304-9440
Practice Address - Street 1:670 W ARAPAHO RD STE 3
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4213
Practice Address - Country:US
Practice Address - Phone:469-914-0003
Practice Address - Fax:800-304-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty