Provider Demographics
NPI:1700105848
Name:DFW CROWN DENTAL OF SOUTH LANCASTER PC
Entity Type:Organization
Organization Name:DFW CROWN DENTAL OF SOUTH LANCASTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TU
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-793-8102
Mailing Address - Street 1:5319 RIVER LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0713
Mailing Address - Country:US
Mailing Address - Phone:817-793-8102
Mailing Address - Fax:
Practice Address - Street 1:2729 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-3114
Practice Address - Country:US
Practice Address - Phone:214-371-3131
Practice Address - Fax:214-371-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty