Provider Demographics
NPI:1609127356
Name:CENTRE FOR DIAGNOSTIC AND COSMETIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:CENTRE FOR DIAGNOSTIC AND COSMETIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:POWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-612-9948
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5463
Mailing Address - Country:US
Mailing Address - Phone:972-964-5928
Mailing Address - Fax:972-612-4498
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-612-4498
Practice Address - Fax:972-612-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental