Provider Demographics
NPI:1811227473
Name:EMMANUEL DENTAL P.A.
Entity Type:Organization
Organization Name:EMMANUEL DENTAL P.A.
Other - Org Name:SAFE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-238-7233
Mailing Address - Street 1:445 WALNUT ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5649
Mailing Address - Country:US
Mailing Address - Phone:972-238-7233
Mailing Address - Fax:972-238-8993
Practice Address - Street 1:445 WALNUT ST
Practice Address - Street 2:SUITE 133
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5649
Practice Address - Country:US
Practice Address - Phone:972-238-7233
Practice Address - Fax:972-238-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720259088OtherPROVIDER INDIVIDUAL NPI