# CHARISMA DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114513256
- **Authorized official:** DR. DULCE Y DE JESUS DDS (DENTIST)
- **Authorized official phone:** (469) 703-8030

## Contact information

- **Practice address:** 557 E US HIGHWAY 80, SUITE 130, FORNEY, TX 75126
- **Practice address phone:** (469) 703-8030
- **Practice address fax:** (469) 703-8031
- **Mailing address:** 557 E US HIGHWAY 80, SUITE 130, FORNEY, TX 75126
- **Mailing address phone:** (469) 703-8030
- **Mailing address fax:** (469) 703-8031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 1223X2210X | Orofacial Pain Dentistry | — | NULL | — |
| 1223X2210X | Orofacial Pain Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/14/2020
- **Last updated:** 09/23/2024