Provider Demographics
NPI:1790292357
Name:TEAP PLLC
Entity Type:Organization
Organization Name:TEAP PLLC
Other - Org Name:WALNUT HILL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:KIRSTIN
Authorized Official - Last Name:HOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-676-7534
Mailing Address - Street 1:8355 WALNUT HILL LN STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4240
Mailing Address - Country:US
Mailing Address - Phone:214-361-2208
Mailing Address - Fax:214-739-6373
Practice Address - Street 1:8355 WALNUT HILL LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4240
Practice Address - Country:US
Practice Address - Phone:214-361-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty