Provider Demographics
NPI:1396115671
Name:HEAVENLY DENTAL, P.C.
Entity type:Organization
Organization Name:HEAVENLY DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-542-4402
Mailing Address - Street 1:1434 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1434 N CENTRAL EXPY
Practice Address - Street 2:SUITE 121
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3106
Practice Address - Country:US
Practice Address - Phone:972-542-4402
Practice Address - Fax:972-542-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty