Provider Demographics
NPI:1194157016
Name:TEXAS REDBUD DENTAL PC
Entity type:Organization
Organization Name:TEXAS REDBUD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-585-0268
Mailing Address - Street 1:1575 REDBUD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3226
Mailing Address - Country:US
Mailing Address - Phone:214-585-0268
Mailing Address - Fax:214-585-0284
Practice Address - Street 1:1575 REDBUD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3226
Practice Address - Country:US
Practice Address - Phone:214-585-0268
Practice Address - Fax:214-585-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty