Tx Southern Dental Ppo PC
Dentist, General Practice in Plano, TX. Organization (NPI-2).
NPI number1982203873
StatusActive
Last updated in NPPESJan 5, 2024
Details
- NPI
- 1982203873
- Entity type
- Organization (NPI-2)
- Legal business name
- Tx Southern Dental Ppo PC
- Organization subpart
- Yes
- Enumeration date
- Oct 21, 2020
- Certification date
- Jul 28, 2023
- Last updated
- Jan 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
| 122300000X | Dentist | – | – |
Other names
- Imagecare Dental Group (Doing Business As)
Practice location
6841 Coit RdPlano, TX 75024-5489
Phone 972-618-5000 · Fax 972-618-9369
Mailing address
5830 Granite Pkwy Ste 780Plano, TX 75024-6775
Authorized official
Christine Nelson
Vp, Revenue Cycle
4694506482
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