Provider Demographics
NPI:1881908259
Name:HEBRON FAMILY DENTAL & ORTHODONTICS
Entity type:Organization
Organization Name:HEBRON FAMILY DENTAL & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERANGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-306-2400
Mailing Address - Street 1:2501 E HEBRON PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4468
Mailing Address - Country:US
Mailing Address - Phone:972-306-2400
Mailing Address - Fax:
Practice Address - Street 1:2501 E HEBRON PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4468
Practice Address - Country:US
Practice Address - Phone:972-306-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty