Provider Demographics
NPI:1871833574
Name:PRUDENT FAMILY DENTISTRY OF CARROLLTON PLLC
Entity Type:Organization
Organization Name:PRUDENT FAMILY DENTISTRY OF CARROLLTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-873-0844
Mailing Address - Street 1:3355 TRINITY MILLS RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6275
Mailing Address - Country:US
Mailing Address - Phone:972-306-3282
Mailing Address - Fax:972-862-6792
Practice Address - Street 1:15110 DALLAS PKWY
Practice Address - Street 2:SUITE 470
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4635
Practice Address - Country:US
Practice Address - Phone:972-512-0285
Practice Address - Fax:972-239-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty