Provider Demographics
NPI:1750976130
Name:EASTLAND DENTAL PLLC
Entity type:Organization
Organization Name:EASTLAND DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTISTW
Authorized Official - Prefix:
Authorized Official - First Name:KAMALPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-759-2152
Mailing Address - Street 1:963 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-3014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:963 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-3014
Practice Address - Country:US
Practice Address - Phone:254-488-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental