Provider Demographics
NPI:1992203376
Name:DE JESUS, DULCE
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 KELLER SPRINGS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3014
Mailing Address - Country:US
Mailing Address - Phone:469-501-2660
Mailing Address - Fax:
Practice Address - Street 1:1735 KELLER SPRINGS RD STE 212
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3014
Practice Address - Country:US
Practice Address - Phone:469-501-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992203376OtherNPI
TX1114513256OtherNPI
TX1396331435OtherNPI