Provider Demographics
NPI:1689014102
Name:PRUDENT FAMILY DENTISTRY OF NORTH DALLAS PLLC
Entity Type:Organization
Organization Name:PRUDENT FAMILY DENTISTRY OF NORTH DALLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-512-0285
Mailing Address - Street 1:15110 DALLAS PKWY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD
Practice Address - Street 2:SUITE 224
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1221
Practice Address - Country:US
Practice Address - Phone:972-512-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty