Provider Demographics
NPI:1740561000
Name:E.Q. DENTAL
Entity Type:Organization
Organization Name:E.Q. DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-741-4567
Mailing Address - Street 1:3529 HERITAGE TRACE PKWY
Mailing Address - Street 2:171
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4970
Mailing Address - Country:US
Mailing Address - Phone:817-741-4567
Mailing Address - Fax:817-741-4576
Practice Address - Street 1:3529 HERITAGE TRACE PKWY
Practice Address - Street 2:171
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4970
Practice Address - Country:US
Practice Address - Phone:817-741-4567
Practice Address - Fax:817-741-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty