Provider Demographics
NPI:1891325726
Name:PEDIATRIC DENTISTRY OF FLOWER MOUND
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF FLOWER MOUND
Other - Org Name:DEBRA C. DUFFY DDS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TERESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-724-1617
Mailing Address - Street 1:2701 OLD SETTLERS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4728
Mailing Address - Country:US
Mailing Address - Phone:972-724-1617
Mailing Address - Fax:
Practice Address - Street 1:2701 OLD SETTLERS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4728
Practice Address - Country:US
Practice Address - Phone:972-724-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty