Provider Demographics
NPI:1083879597
Name:ATLANTIS DENTAL CARE, P.C,
Entity type:Organization
Organization Name:ATLANTIS DENTAL CARE, P.C,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LALIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARDWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-941-9400
Mailing Address - Street 1:330 S ZANG BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6622
Mailing Address - Country:US
Mailing Address - Phone:214-941-9400
Mailing Address - Fax:
Practice Address - Street 1:330 S ZANG BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6622
Practice Address - Country:US
Practice Address - Phone:214-941-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty