Provider Demographics
NPI:1780223339
Name:BEYOND PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BEYOND PEDIATRIC DENTISTRY
Other - Org Name:DALLAS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-808-6825
Mailing Address - Street 1:8411 PRESTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5517
Mailing Address - Country:US
Mailing Address - Phone:082-808-6825
Mailing Address - Fax:
Practice Address - Street 1:8411 PRESTON RD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5517
Practice Address - Country:US
Practice Address - Phone:972-808-6825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821361858OtherNPPES