Provider Demographics
NPI:1154576742
Name:PRISMA DENTAL
Entity type:Organization
Organization Name:PRISMA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-665-1643
Mailing Address - Street 1:1701 STILLHOUSE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7202
Mailing Address - Country:US
Mailing Address - Phone:972-886-5493
Mailing Address - Fax:
Practice Address - Street 1:5566 MAIN STREET
Practice Address - Street 2:SUITE150
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-731-9800
Practice Address - Fax:972-731-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty