Provider Demographics
NPI:1700091667
Name:MY DENTIST PLLC DBA SPRING CREEK DENTAL
Entity Type:Organization
Organization Name:MY DENTIST PLLC DBA SPRING CREEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHALAKA
Authorized Official - Middle Name:ABHIJIT
Authorized Official - Last Name:NESARIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-964-1122
Mailing Address - Street 1:6205 COIT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5473
Mailing Address - Country:US
Mailing Address - Phone:972-964-1122
Mailing Address - Fax:972-964-9595
Practice Address - Street 1:6205 COIT RD STE 130
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5473
Practice Address - Country:US
Practice Address - Phone:972-964-1122
Practice Address - Fax:972-964-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID