| Midentista, Pllc | |
|
101 Decker Bldg. 200, Ste. 260 Irving TX 75062 | |
| (972) 717-0660 | |
| (972) 717-0663 |
| Full Name | Midentista, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 101 Decker, Irving, Texas |
| Authorized Official Name and Position | Angel Gonzalez (PRESIDENT) |
| Authorized Official Contact | 9727170660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midentista, Pllc 101 Decker Bldg. 200, Ste. 260 Irving TX 75062 Ph: (972) 717-0660 | Midentista, Pllc 101 Decker Bldg. 200, Ste. 260 Irving TX 75062 Ph: (972) 717-0660 |
| NPI Number | 1922335272 |
|---|---|
| Provider Enumeration Date | 11/06/2009 |
| Last Update Date | 11/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922335272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 18837 (Texas) | Primary |
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