Provider Demographics
NPI:1619334463
Name:PLAZA DENTAL CENTER PA
Entity Type:Organization
Organization Name:PLAZA DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIN
Authorized Official - Middle Name:X
Authorized Official - Last Name:WENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-208-9998
Mailing Address - Street 1:4140 LEGACY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3495
Mailing Address - Country:US
Mailing Address - Phone:972-208-9998
Mailing Address - Fax:972-208-9995
Practice Address - Street 1:4140 LEGACY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3495
Practice Address - Country:US
Practice Address - Phone:972-208-9998
Practice Address - Fax:972-208-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18039302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization