Provider Demographics
NPI:1104156843
Name:DENTAL DELITE PG PA
Entity type:Organization
Organization Name:DENTAL DELITE PG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-398-1234
Mailing Address - Street 1:8228 BRUTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1902
Mailing Address - Country:US
Mailing Address - Phone:214-398-1234
Mailing Address - Fax:
Practice Address - Street 1:8228 BRUTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1902
Practice Address - Country:US
Practice Address - Phone:214-398-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty