| Texas Prime Dental Group Ii Pc | |
|
14075 Waterfall Way Dallas TX 75240-3841 | |
| (972) 783-5711 | |
| Not Available |
| Full Name | Texas Prime Dental Group Ii Pc |
|---|---|
| Speciality | Dentist |
| Location | 14075 Waterfall Way, Dallas, Texas |
| Authorized Official Name and Position | Milton Dang (PARTNER) |
| Authorized Official Contact | 9727835711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Texas Prime Dental Group Ii Pc 14075 Waterfall Way Dallas TX 75240-3841 Ph: (972) 783-5711 | Texas Prime Dental Group Ii Pc 14075 Waterfall Way Dallas TX 75240-3841 Ph: (972) 783-5711 |
| NPI Number | 1457973224 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 11/03/2020 |
| Medicare PECOS PAC ID | 8224448162 |
|---|---|
| Medicare Enrollment ID | O20201105000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457973224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | An Quoc Le |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1447379128 PECOS PAC ID: 9133539075 Enrollment ID: I20201105000400 |
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