Provider Demographics
NPI:1841551421
Name:DENTISTRY BY DESIGN PA
Entity type:Organization
Organization Name:DENTISTRY BY DESIGN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:TINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-231-3013
Mailing Address - Street 1:3013 E RENNER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3577
Mailing Address - Country:US
Mailing Address - Phone:972-231-3013
Mailing Address - Fax:
Practice Address - Street 1:3013 E RENNER RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3577
Practice Address - Country:US
Practice Address - Phone:972-231-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty