Provider Demographics
NPI:1891352985
Name:ARDENT DENTAL & IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:ARDENT DENTAL & IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUPITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-616-6148
Mailing Address - Street 1:737 IRBY LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7056
Mailing Address - Country:US
Mailing Address - Phone:972-259-3614
Mailing Address - Fax:972-259-1920
Practice Address - Street 1:737 IRBY LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7056
Practice Address - Country:US
Practice Address - Phone:972-259-3614
Practice Address - Fax:972-259-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental