Provider Demographics
NPI:1831582725
Name:DFW DENTAL ASSOCIATES, PA
Entity type:Organization
Organization Name:DFW DENTAL ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-905-4759
Mailing Address - Street 1:2711 LBJ FWY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7315
Mailing Address - Country:US
Mailing Address - Phone:972-905-4759
Mailing Address - Fax:
Practice Address - Street 1:300 S COTTONWOOD DR
Practice Address - Street 2:SUITE F
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5751
Practice Address - Country:US
Practice Address - Phone:972-644-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty