Provider Demographics
NPI:1154552701
Name:PROSPER DENTISTRY & ORTHODONTICS, PA
Entity type:Organization
Organization Name:PROSPER DENTISTRY & ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-743-9811
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-0993
Mailing Address - Country:US
Mailing Address - Phone:972-743-9811
Mailing Address - Fax:
Practice Address - Street 1:110 N PRESTON RD STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8644
Practice Address - Country:US
Practice Address - Phone:972-346-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty