Provider Demographics
NPI:1811668643
Name:DFW STADIUM DENTAL PC
Entity type:Organization
Organization Name:DFW STADIUM DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-323-5522
Mailing Address - Street 1:1514 E ABRAM ST STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7259
Mailing Address - Country:US
Mailing Address - Phone:682-323-5522
Mailing Address - Fax:
Practice Address - Street 1:1514 E ABRAM ST STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7259
Practice Address - Country:US
Practice Address - Phone:682-323-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty