Provider Demographics
NPI:1750539276
Name:TRINITY FAMILY DENTAL
Entity type:Organization
Organization Name:TRINITY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JASDEEP
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-283-3801
Mailing Address - Street 1:800 N INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-7400
Mailing Address - Country:US
Mailing Address - Phone:817-283-3801
Mailing Address - Fax:817-283-6309
Practice Address - Street 1:800 N INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7400
Practice Address - Country:US
Practice Address - Phone:817-283-3801
Practice Address - Fax:817-283-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22368305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization