Provider Demographics
NPI:1861840845
Name:WEST SHORE FAMILY DENTAL
Entity Type:Organization
Organization Name:WEST SHORE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN-BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-235-3675
Mailing Address - Street 1:1110 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4054
Mailing Address - Country:US
Mailing Address - Phone:972-235-3675
Mailing Address - Fax:
Practice Address - Street 1:1110 W SHORE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4054
Practice Address - Country:US
Practice Address - Phone:972-235-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty