Provider Demographics
NPI:1760967582
Name:TRAIL CREEK DENTAL PLLC
Entity Type:Organization
Organization Name:TRAIL CREEK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-283-5376
Mailing Address - Street 1:350 WESTPARK WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3965
Mailing Address - Country:US
Mailing Address - Phone:817-283-5376
Mailing Address - Fax:817-502-6494
Practice Address - Street 1:350 WESTPARK WAY STE 200
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3965
Practice Address - Country:US
Practice Address - Phone:817-283-5376
Practice Address - Fax:817-502-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty