| The Dentist Off Main, Pllc | |
|
1245 S. Main St. Suite 100 Grapevine TX 76051 | |
| (817) 527-1590 | |
| (940) 497-3010 |
| Full Name | The Dentist Off Main, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1245 S. Main St., Grapevine, Texas |
| Authorized Official Name and Position | Richard Bernard Luczak (CEO) |
| Authorized Official Contact | 8175271590 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Dentist Off Main, Pllc 1245 S. Main St. Suite 100 Grapevine TX 76051 Ph: (817) 527-1590 | The Dentist Off Main, Pllc 1245 S. Main St. Suite 100 Grapevine TX 76051 Ph: (817) 527-1590 |
| NPI Number | 1396184693 |
|---|---|
| Provider Enumeration Date | 06/19/2013 |
| Last Update Date | 06/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396184693 | NPI | - | NPPES |
| 870515 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19398 (Texas) | Primary |
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