Provider Demographics
NPI:1679207641
Name:TARRANT DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:TARRANT DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-662-3105
Mailing Address - Street 1:5000 LEGACY DR STE 240
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3112
Mailing Address - Country:US
Mailing Address - Phone:646-662-3105
Mailing Address - Fax:
Practice Address - Street 1:5310 N TARRANT PKWY STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5386
Practice Address - Country:US
Practice Address - Phone:817-849-9777
Practice Address - Fax:817-887-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty