Provider Demographics
NPI:1639592975
Name:PUKAPLLC
Entity Type:Organization
Organization Name:PUKAPLLC
Other - Org Name:FAMILY DENTAL OF MCKINNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-742-0793
Mailing Address - Street 1:1321 N TENNESSEE ST
Mailing Address - Street 2:108
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-2142
Mailing Address - Country:US
Mailing Address - Phone:469-742-0793
Mailing Address - Fax:469-742-9937
Practice Address - Street 1:1321 N TENNESSEE ST
Practice Address - Street 2:108
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-2142
Practice Address - Country:US
Practice Address - Phone:469-742-0793
Practice Address - Fax:469-742-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty