Provider Demographics
NPI:1598918955
Name:PACIFIC DENTAL CENTER LLC
Entity Type:Organization
Organization Name:PACIFIC DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-567-7450
Mailing Address - Street 1:3043 OLD DENTON RD
Mailing Address - Street 2:108
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3043 OLD DENTON RD
Practice Address - Street 2:108
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5036
Practice Address - Country:US
Practice Address - Phone:972-567-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0204761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty