| Flower Mound Dentistry Divine | |
|
2200 Morriss Rd Ste 150 Flower Mound TX 75028-3239 | |
| (972) 539-4290 | |
| (972) 355-1736 |
| Full Name | Flower Mound Dentistry Divine |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2200 Morriss Rd Ste 150, Flower Mound, Texas |
| Authorized Official Name and Position | Kiamesha Michalle Mcclellan (PRESIDENT) |
| Authorized Official Contact | 9725394290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Flower Mound Dentistry Divine 2200 Morriss Rd Ste 150 Flower Mound TX 75028-3239 Ph: (972) 539-4290 | Flower Mound Dentistry Divine 2200 Morriss Rd Ste 150 Flower Mound TX 75028-3239 Ph: (972) 539-4290 |
| NPI Number | 1235340365 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235340365 | NPI | - | NPPES |
| 1144438060 | Other | TX | INDIVIDUAL PIN NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 15884 (Texas) | Primary |
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