Provider Demographics
NPI:1134737919
Name:AFFORDABLE DENTIST NEAR ME GRAND PRAIRIE, PLLC
Entity type:Organization
Organization Name:AFFORDABLE DENTIST NEAR ME GRAND PRAIRIE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLOMEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-810-6239
Mailing Address - Street 1:5416 BASSWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4400
Mailing Address - Country:US
Mailing Address - Phone:817-656-1215
Mailing Address - Fax:
Practice Address - Street 1:2501 W INTERSTATE 20 STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3948
Practice Address - Country:US
Practice Address - Phone:817-496-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty