Provider Demographics
NPI:1639512403
Name:PECAN TREE DENTAL
Entity Type:Organization
Organization Name:PECAN TREE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-262-5111
Mailing Address - Street 1:775 W WESTCHESTER PKWY
Mailing Address - Street 2:#101
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2856
Mailing Address - Country:US
Mailing Address - Phone:972-262-5111
Mailing Address - Fax:972-262-6812
Practice Address - Street 1:775 W WESTCHESTER PKWY
Practice Address - Street 2:#101
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2856
Practice Address - Country:US
Practice Address - Phone:972-262-5111
Practice Address - Fax:972-262-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty