Provider Demographics
NPI:1265157978
Name:8901 TEHAMA RIDGE PKWY PLLC
Entity type:Organization
Organization Name:8901 TEHAMA RIDGE PKWY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-809-4860
Mailing Address - Street 1:2401 E RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6349
Mailing Address - Country:US
Mailing Address - Phone:817-809-4860
Mailing Address - Fax:682-626-1824
Practice Address - Street 1:8901 TEHAMA RIDGE PKWY STE 119
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2032
Practice Address - Country:US
Practice Address - Phone:214-317-4039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty