Provider Demographics
NPI:1134158330
Name:DENTAL IMPLANT SURGERY CENTER
Entity type:Organization
Organization Name:DENTAL IMPLANT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL SURGEON, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHINEDLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-527-4867
Mailing Address - Street 1:7965 CUSTER ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3155
Mailing Address - Country:US
Mailing Address - Phone:972-527-4867
Mailing Address - Fax:972-665-1818
Practice Address - Street 1:7965 CUSTER ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3155
Practice Address - Country:US
Practice Address - Phone:972-527-4867
Practice Address - Fax:972-665-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty