Provider Demographics
NPI:1609264670
Name:NATURAL DENTISTRY OF NORTH TEXAS, PLLC
Entity Type:Organization
Organization Name:NATURAL DENTISTRY OF NORTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOTTFRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-616-7161
Mailing Address - Street 1:1645 N TOWN EAST BLVD STE 532
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4147
Mailing Address - Country:US
Mailing Address - Phone:214-616-7161
Mailing Address - Fax:972-681-5986
Practice Address - Street 1:1645 N TOWN EAST BLVD STE 532
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4147
Practice Address - Country:US
Practice Address - Phone:214-616-7161
Practice Address - Fax:972-681-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12609261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental