Provider Demographics
NPI:1972278943
Name:DFW DENTAL CAPITAL PC
Entity Type:Organization
Organization Name:DFW DENTAL CAPITAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-273-1376
Mailing Address - Street 1:3330 N GALLOWAY AVE STE 158
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4701
Mailing Address - Country:US
Mailing Address - Phone:469-273-1376
Mailing Address - Fax:
Practice Address - Street 1:3330 N GALLOWAY AVE STE 158
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4701
Practice Address - Country:US
Practice Address - Phone:469-273-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty