Provider Demographics
NPI:1679250344
Name:E DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:E DENTAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZINWANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EJESIEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-519-4308
Mailing Address - Street 1:3005 E RENNER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD STE 224
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1225
Practice Address - Country:US
Practice Address - Phone:972-233-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty