Individual
CIGDEM ER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2520 K AVE STE 180, PLANO, TX 75074-5378
(972) 423-1234
(972) 424-6543
Mailing address
2520 K AVE STE 180, PLANO, TX 75074-5378
(972) 423-1234
(972) 424-6543
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901021817
MI
1223G0001X
General Practice Dentistry
Primary
30472
TX
Other
Enumeration date
12/30/2014
Last updated
04/21/2021
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