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Organization
TX SOUTHERN DENTAL PPO PC
Active
Organization
TX SOUTHERN DENTAL PPO PC
Active
Parent organization
TX SOUTHERN DENTAL PPO PC
Other names
Imagecare Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
TX SOUTHERN DENTAL PPO PC
Authorized official
CHRISTINE NELSON (VP, REVENUE CYCLE)
(469) 450-6482
Entity
Organization
Contact information
Practice address
6841 COIT RD, PLANO, TX 75024-5489
(972) 618-5000
(972) 618-9369
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/21/2020
Last updated
01/05/2024
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