Organization
TEXAS WISDOM TEETH & DENTAL IMPLANTS
Active
Organization
TEXAS WISDOM TEETH & DENTAL IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KOTLIAR (MANAGER)
(631) 365-3268
Entity
Organization
Contact information
Practice address
14856 PRESTON RD STE 104, DALLAS, TX 75254-6844
(972) 960-1111
Mailing address
14856 PRESTON RD STE 104, DALLAS, TX 75254-6844
(972) 960-1111
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/17/2016
Last updated
06/17/2016
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