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1921 W 15th St Suite 100 Plano TX 75075-7337 | |
| (972) 827-8779 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1921 W 15th St, Plano, Texas |
| Authorized Official Name and Position | Soumya Banerjee (MANAGING MENBER) |
| Authorized Official Contact | 8083196804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9532 Valley Ranch Pkwy E #1098 Irving TX 75063-4903 Ph: (808) 319-6805 | 1921 W 15th St Suite 100 Plano TX 75075-7337 Ph: (972) 827-8779 |
| NPI Number | 1033641675 |
|---|---|
| Provider Enumeration Date | 04/02/2017 |
| Last Update Date | 04/02/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033641675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 29844 (Texas) | Primary |
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