Provider Demographics
NPI:1306456421
Name:EXPERIENCE DENTAL PLLC
Entity type:Organization
Organization Name:EXPERIENCE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-214-9998
Mailing Address - Street 1:1913 OAKSTON DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1506
Mailing Address - Country:US
Mailing Address - Phone:201-214-9988
Mailing Address - Fax:214-237-6096
Practice Address - Street 1:7001 S CUSTER RD
Practice Address - Street 2:STE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7507
Practice Address - Country:US
Practice Address - Phone:201-214-9998
Practice Address - Fax:214-237-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental