Provider Demographics
NPI:1659002251
Name:IRVING TX DENTAL PLLC
Entity Type:Organization
Organization Name:IRVING TX DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAMALPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-504-4543
Mailing Address - Street 1:13551 SPOKANE WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:737 IRBY LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7056
Practice Address - Country:US
Practice Address - Phone:972-504-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental