Provider Demographics
NPI:1760771497
Name:HEARTLAND DENTAL CARE OF TX, P.C.
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TX, P.C.
Other - Org Name:VIRGINIA PARKWAY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:2411 VIRGINIA PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3508
Mailing Address - Country:US
Mailing Address - Phone:972-540-2800
Mailing Address - Fax:972-542-1182
Practice Address - Street 1:2411 VIRGINIA PKWY STE 2
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3508
Practice Address - Country:US
Practice Address - Phone:972-540-2800
Practice Address - Fax:972-542-1182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TX, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty