Provider Demographics
NPI:1265304893
Name:MA1HOLDINGS DBA PROACTIVE DENTAL
Entity type:Organization
Organization Name:MA1HOLDINGS DBA PROACTIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIVNANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-781-1880
Mailing Address - Street 1:5933 DALLAS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8521
Mailing Address - Country:US
Mailing Address - Phone:972-781-1880
Mailing Address - Fax:972-781-0588
Practice Address - Street 1:5933 DALLAS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8521
Practice Address - Country:US
Practice Address - Phone:972-781-1880
Practice Address - Fax:972-781-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty