| Lavender Dental | |
|
5103 Magna Carta Blvd Suite 100 Grand Prairie TX 75052-5213 | |
| (972) 352-6677 | |
| (972) 352-6678 |
| Full Name | Lavender Dental |
|---|---|
| Speciality | Dentist |
| Location | 5103 Magna Carta Blvd, Grand Prairie, Texas |
| Authorized Official Name and Position | Shaneka Marks Moss (OWNER) |
| Authorized Official Contact | 9723526677 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavender Dental 5103 Magna Carta Blvd Suite 100 Grand Prairie TX 75052-5213 Ph: (972) 352-6677 | Lavender Dental 5103 Magna Carta Blvd Suite 100 Grand Prairie TX 75052-5213 Ph: (972) 352-6677 |
| NPI Number | 1487080404 |
|---|---|
| Provider Enumeration Date | 09/23/2013 |
| Last Update Date | 09/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487080404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 25693 (Texas) | Primary |
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