Provider Demographics
NPI:1760727952
Name:DALLAS DENTAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:DALLAS DENTAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-754-0111
Mailing Address - Street 1:2702 MCKINNEY AVE
Mailing Address - Street 2:200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2508
Mailing Address - Country:US
Mailing Address - Phone:214-754-0111
Mailing Address - Fax:214-754-0112
Practice Address - Street 1:2702 MCKINNEY AVE
Practice Address - Street 2:200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2508
Practice Address - Country:US
Practice Address - Phone:214-754-0111
Practice Address - Fax:214-754-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty