Provider Demographics
NPI:1003701186
Name:EXCELLENTIA PLLC
Entity type:Organization
Organization Name:EXCELLENTIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTAL PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEMOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-553-9494
Mailing Address - Street 1:3512 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-2352
Mailing Address - Country:US
Mailing Address - Phone:202-553-9494
Mailing Address - Fax:
Practice Address - Street 1:4275 MILES RD
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4886
Practice Address - Country:US
Practice Address - Phone:469-589-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty