Provider Demographics
NPI:1265077374
Name:TOOTHHQ DENTAL SPECIALISTS DALLAS PLLC
Entity type:Organization
Organization Name:TOOTHHQ DENTAL SPECIALISTS DALLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-859-0444
Mailing Address - Street 1:6333 E MOCKINGBIRD LN STE 254
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2307
Mailing Address - Country:US
Mailing Address - Phone:214-731-0123
Mailing Address - Fax:
Practice Address - Street 1:6333 E MOCKINGBIRD LN STE 254
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2307
Practice Address - Country:US
Practice Address - Phone:214-731-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty