Provider Demographics
NPI:1801153382
Name:MOCKINGBIRD DENTAL GROUP, PC
Entity type:Organization
Organization Name:MOCKINGBIRD DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:DEES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-270-4456
Mailing Address - Street 1:PO BOX 678636
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1534 E INTERSTATE 30
Practice Address - Street 2:SUITE 300
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4788
Practice Address - Country:US
Practice Address - Phone:972-270-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty