Provider Demographics
NPI:1942846340
Name:TX SOUTHERN DENTAL PC
Entity Type:Organization
Organization Name:TX SOUTHERN DENTAL PC
Other - Org Name:HILL DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-450-6482
Mailing Address - Street 1:5830 GRANITE PKWY STE 780
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1710 N GREENVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8862
Practice Address - Country:US
Practice Address - Phone:972-727-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TX SOUTHERN DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty