Provider Demographics
NPI:1770804577
Name:DENTAL GROUP OF MESQUITE, PLLC
Entity type:Organization
Organization Name:DENTAL GROUP OF MESQUITE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-215-7325
Mailing Address - Street 1:2690 N. GALLOWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4857
Mailing Address - Country:US
Mailing Address - Phone:972-279-1200
Mailing Address - Fax:972-279-1203
Practice Address - Street 1:2690 N. GALLOWAY AVE.
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4857
Practice Address - Country:US
Practice Address - Phone:972-279-1200
Practice Address - Fax:972-279-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00253581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty