Provider Demographics
NPI:1821619941
Name:ARCHIE DENTAL PLLC
Entity Type:Organization
Organization Name:ARCHIE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-422-9381
Mailing Address - Street 1:2208 W PARK ROW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7408
Mailing Address - Country:US
Mailing Address - Phone:817-422-9280
Mailing Address - Fax:682-323-5499
Practice Address - Street 1:2208 W PARK ROW DR STE 102
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-7408
Practice Address - Country:US
Practice Address - Phone:817-422-9280
Practice Address - Fax:682-323-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty