Provider Demographics
NPI:1912074485
Name:DALLAS CENTER FOR COSMETIC DENTISTRY PA
Entity Type:Organization
Organization Name:DALLAS CENTER FOR COSMETIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-692-1700
Mailing Address - Street 1:6136 SHERRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6301
Mailing Address - Country:US
Mailing Address - Phone:214-692-1700
Mailing Address - Fax:214-368-6546
Practice Address - Street 1:6136 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6301
Practice Address - Country:US
Practice Address - Phone:214-692-1700
Practice Address - Fax:214-368-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty