Provider Demographics
NPI:1770960759
Name:DALLAS DENTAL CARE, LLC
Entity type:Organization
Organization Name:DALLAS DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-725-4545
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-0246
Mailing Address - Country:US
Mailing Address - Phone:229-725-4545
Mailing Address - Fax:229-725-4469
Practice Address - Street 1:471 PIONEER RD NW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-0246
Practice Address - Country:US
Practice Address - Phone:229-725-4545
Practice Address - Fax:229-725-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13565122300000X
GA8983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty