Provider Demographics
NPI:1922421981
Name:PRUDENT FAMILY DENTISTRY OF MESQUITE PLLC
Entity Type:Organization
Organization Name:PRUDENT FAMILY DENTISTRY OF MESQUITE PLLC
Other - Org Name:AZ DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-512-0285
Mailing Address - Street 1:15110 DALLAS PKWY
Mailing Address - Street 2:470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3434 TOWNE CROSSING BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2782
Practice Address - Country:US
Practice Address - Phone:972-512-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty