| Fresh Dental-shreveport | |
|
7301 State Highway 161 Ste 198 Irving TX 75039-2880 | |
| (972) 869-3789 | |
| (972) 869-3791 |
| Full Name | Fresh Dental-shreveport |
|---|---|
| Speciality | Dentist |
| Location | 7301 State Highway 161 Ste 198, Irving, Texas |
| Authorized Official Name and Position | Mary Pu (VP OF FINANCE) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Dental-shreveport 7301 State Highway 161 Ste 198 Irving TX 75039-2880 Ph: (972) 869-3789 | Fresh Dental-shreveport 7301 State Highway 161 Ste 198 Irving TX 75039-2880 Ph: (972) 869-3789 |
| NPI Number | 1073880639 |
|---|---|
| Provider Enumeration Date | 11/28/2011 |
| Last Update Date | 11/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073880639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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