Provider Demographics
NPI:1154547057
Name:DENTAL REPUBLIC - BUCKNER, PC
Entity type:Organization
Organization Name:DENTAL REPUBLIC - BUCKNER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-747-1400
Mailing Address - Street 1:508 W MCDERMOTT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2777
Mailing Address - Country:US
Mailing Address - Phone:972-747-1400
Mailing Address - Fax:
Practice Address - Street 1:2336 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8605
Practice Address - Country:US
Practice Address - Phone:214-381-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty