Provider Demographics
NPI:1730370545
Name:DFWFAMILY DENTAL CENTERS PLLC
Entity type:Organization
Organization Name:DFWFAMILY DENTAL CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-675-8753
Mailing Address - Street 1:3605 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2122
Mailing Address - Country:US
Mailing Address - Phone:817-675-8753
Mailing Address - Fax:
Practice Address - Street 1:4800 S HULEN ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1400
Practice Address - Country:US
Practice Address - Phone:817-877-4867
Practice Address - Fax:214-599-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty