Provider Demographics
NPI:1972363729
Name:TRIBUTE FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:TRIBUTE FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHARVAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-699-2519
Mailing Address - Street 1:4713 HIGHWAY 121 STE 304
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2901
Mailing Address - Country:US
Mailing Address - Phone:972-538-4343
Mailing Address - Fax:
Practice Address - Street 1:5605 FM 423 STE 600
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8962
Practice Address - Country:US
Practice Address - Phone:469-598-1021
Practice Address - Fax:469-598-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty