Provider Demographics
NPI:1194879817
Name:MAINKER, PRIYA (DMD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:MAINKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 MCDERMOTT DR
Mailing Address - Street 2:STE#200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7738
Mailing Address - Country:US
Mailing Address - Phone:214-618-6250
Mailing Address - Fax:972-692-5614
Practice Address - Street 1:4032 MCDERMOTT DR
Practice Address - Street 2:STE#200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7738
Practice Address - Country:US
Practice Address - Phone:214-618-6250
Practice Address - Fax:972-692-5614
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX432021386OtherTAX ID #