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Organization
MI DENTISTA
Active
Organization
MI DENTISTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOAMMI RODRIGUEZ (CREDENTIALING MANAGER)
(214) 335-5013
Entity
Organization
Contact information
Practice address
3101 W DAVIS ST, DALLAS, TX 75211-2921
(469) 399-1553
Mailing address
3101 W DAVIS ST, DALLAS, TX 75211-2921
(469) 399-1553
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/22/2020
Last updated
04/19/2023
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