Provider Demographics
NPI:1720099716
Name:NORTH CENTRAL DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:NORTH CENTRAL DENTAL SERVICES PLLC
Other - Org Name:SUNRISE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-235-0300
Mailing Address - Street 1:811 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7415
Mailing Address - Country:US
Mailing Address - Phone:972-235-0300
Mailing Address - Fax:972-235-3203
Practice Address - Street 1:811 S CENTRAL EXPY
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7415
Practice Address - Country:US
Practice Address - Phone:972-235-0300
Practice Address - Fax:972-235-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty