Provider Demographics
NPI:1811151327
Name:SHEPHERD LANE DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SHEPHERD LANE DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-385-9331
Mailing Address - Street 1:3501 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-2325
Mailing Address - Country:US
Mailing Address - Phone:972-286-5711
Mailing Address - Fax:972-286-6106
Practice Address - Street 1:6959 ARAPAHO RD
Practice Address - Street 2:SUITE 551
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4022
Practice Address - Country:US
Practice Address - Phone:972-385-9331
Practice Address - Fax:972-385-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty