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Organization
STEFANUS SISWANTO DDS PLLC
Active
Organization
STEFANUS SISWANTO DDS PLLC
Active
Other names
Midway Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEFANUS H SISWANTO DDS (PRESIDENT)
(214) 934-2198
Entity
Organization
Contact information
Practice address
18181 MIDWAY RD STE 500, DALLAS, TX 75287-8104
(214) 934-2198
Mailing address
18181 MIDWAY RD STE 500, DALLAS, TX 75287-8104
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22440
TX
Other
Enumeration date
05/06/2008
Last updated
05/06/2008
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