Provider Demographics
NPI:1154656171
Name:DENTAL SPA OF TEXAS PC
Entity type:Organization
Organization Name:DENTAL SPA OF TEXAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:AZINGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-377-8177
Mailing Address - Street 1:2995 PRESTON ROAD
Mailing Address - Street 2:SUITE # 1500
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-377-8177
Mailing Address - Fax:972-377-4377
Practice Address - Street 1:2995 PRESTON ROAD
Practice Address - Street 2:# 1500
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-377-8177
Practice Address - Fax:972-377-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty