Provider Demographics
NPI:1962948091
Name:DENTAL RESORT PLLC
Entity type:Organization
Organization Name:DENTAL RESORT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMOVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-400-8008
Mailing Address - Street 1:2100 DALLAS PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4363
Mailing Address - Country:US
Mailing Address - Phone:530-400-8008
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:2100 DALLAS PKWY
Practice Address - Street 2:STE 120
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4363
Practice Address - Country:US
Practice Address - Phone:530-400-8008
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669727558OtherNPI TYPE 1