Organization
EAST LAKE DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT STEVEN DESUTTER DDS (DENTIST)
(972) 559-4185
Entity
Organization
Contact information
Practice address
718 N BUCKNER BLVD STE 110, DALLAS, TX 75218-2764
(214) 295-8440
Mailing address
718 N BUCKNER BLVD STE 110, DALLAS, TX 75218-2764
(214) 295-8440
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/14/2017
Last updated
10/10/2017
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