Provider Demographics
NPI:1881879831
Name:PALOMA CREEK DENTAL
Entity type:Organization
Organization Name:PALOMA CREEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKKAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-347-1090
Mailing Address - Street 1:26735 US HWY 380 E
Mailing Address - Street 2:STE 105
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:972-347-1090
Mailing Address - Fax:972-347-1021
Practice Address - Street 1:26735 US HWY 380 E
Practice Address - Street 2:STE 105
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:972-347-1090
Practice Address - Fax:972-347-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty