Organization
DENTAL DELITE PG PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALARIE BOHANNON (OFFICE MANAGER)
(214) 398-1234
Entity
Organization
Contact information
Practice address
8228 BRUTON RD, DALLAS, TX 75217-1902
(214) 398-1234
Mailing address
8228 BRUTON RD, DALLAS, TX 75217-1902
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13654
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090281902
—
TX
Enumeration date
05/15/2008
Last updated
03/11/2013
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