Provider Demographics
NPI:1821462102
Name:PROSPER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PROSPER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SENTLINGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-989-1966
Mailing Address - Street 1:201 N PRESTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8627
Mailing Address - Country:US
Mailing Address - Phone:972-347-1145
Mailing Address - Fax:972-347-1147
Practice Address - Street 1:201 N PRESTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8627
Practice Address - Country:US
Practice Address - Phone:972-347-1145
Practice Address - Fax:972-347-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty