Provider Demographics
NPI:1730469354
Name:PRACHI DEORE P.A.
Entity Type:Organization
Organization Name:PRACHI DEORE P.A.
Other - Org Name:COPPELL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRACHI
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-315-2200
Mailing Address - Street 1:760 N DENTON TAP RD
Mailing Address - Street 2:#190
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2163
Mailing Address - Country:US
Mailing Address - Phone:972-315-2200
Mailing Address - Fax:972-315-2204
Practice Address - Street 1:760 N DENTON TAP RD
Practice Address - Street 2:#190
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2163
Practice Address - Country:US
Practice Address - Phone:972-315-2200
Practice Address - Fax:972-315-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty