Provider Demographics
NPI:1316257710
Name:T-DENTAL,P.C
Entity type:Organization
Organization Name:T-DENTAL,P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANH
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-390-1384
Mailing Address - Street 1:9625 PLANO ROAD
Mailing Address - Street 2:100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238
Mailing Address - Country:US
Mailing Address - Phone:408-390-1384
Mailing Address - Fax:
Practice Address - Street 1:9625 PLANO ROAD
Practice Address - Street 2:100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238
Practice Address - Country:US
Practice Address - Phone:408-390-1384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty