| 100 Dental | |
|
271 E Southlake Blvd Ste 100 Southlake TX 76092-6272 | |
| (817) 329-6677 | |
| Not Available |
| Full Name | 100 Dental |
|---|---|
| Speciality | Dentist |
| Location | 271 E Southlake Blvd Ste 100, Southlake, Texas |
| Authorized Official Name and Position | Yeu Jin Baik (DENTIST) |
| Authorized Official Contact | 5166406812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 100 Dental 271 E Southlake Blvd Ste 100 Southlake TX 76092-6272 Ph: (817) 329-6677 | 100 Dental 271 E Southlake Blvd Ste 100 Southlake TX 76092-6272 Ph: (817) 329-6677 |
| NPI Number | 1760172779 |
|---|---|
| Provider Enumeration Date | 05/11/2023 |
| Last Update Date | 05/11/2023 |
| Certification Date | 05/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760172779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | () | Primary |
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