Provider Demographics
NPI:1255610895
Name:SIMPLY GOOD DENTAL, P.L.L.C.
Entity type:Organization
Organization Name:SIMPLY GOOD DENTAL, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PINTIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARUNMETHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-867-7883
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-0662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 W SPRING CREEK PKWY
Practice Address - Street 2:A-300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5316
Practice Address - Country:US
Practice Address - Phone:972-867-7883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20795261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental