Provider Demographics
NPI:1770821738
Name:PRESTON HOLLOW PERIODONTICS & IMPLANTOLOGY, PC
Entity Type:Organization
Organization Name:PRESTON HOLLOW PERIODONTICS & IMPLANTOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-350-8001
Mailing Address - Street 1:10246 MIDWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-6233
Mailing Address - Country:US
Mailing Address - Phone:214-350-8001
Mailing Address - Fax:214-350-6383
Practice Address - Street 1:10246 MIDWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-6233
Practice Address - Country:US
Practice Address - Phone:214-350-8001
Practice Address - Fax:214-350-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24589261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental