Provider Demographics
NPI:1821549403
Name:NEW AVENUE DENTISTRY, PLLC
Entity Type:Organization
Organization Name:NEW AVENUE DENTISTRY, PLLC
Other - Org Name:NEW AVENUE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOSHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-905-1359
Mailing Address - Street 1:3007 SKYWAY CIR N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3007 SKYWAY CIR N
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3524
Practice Address - Country:US
Practice Address - Phone:972-905-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty