| Primary Dental Clinic | |
|
6871 Shadybrook Ln Dallas TX 75231-6605 | |
| (469) 939-6691 | |
| Not Available |
| Full Name | Primary Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6871 Shadybrook Ln, Dallas, Texas |
| Authorized Official Name and Position | Kim Bui (SECRETARY) |
| Authorized Official Contact | 4699396691 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Dental Clinic 1906 Village Creek Dr Garland TX 75040-3946 Ph: (469) 939-6691 | Primary Dental Clinic 6871 Shadybrook Ln Dallas TX 75231-6605 Ph: (469) 939-6691 |
| NPI Number | 1669529798 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 03/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669529798 | NPI | - | NPPES |
| 21598 | Other | TX | SBDE TX DENTIST PROVIDER NUMBER |
| B21598-01 | Other | TX | TEXAS CHIP |
| 176322901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 21598 (Texas) | Primary |
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