Organization
DENTAL DELITE PG PA
Active
Parent organization
DENTAL DELITE PG PA
Other names
Dental Delite
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL DELITE PG PA
Authorized official
DOMINIQUE VALLADAREZ (GENERAL MANAGER)
(214) 398-1234
Entity
Organization
Contact information
Practice address
8222 BRUTON RD, DALLAS, TX 75217-1902
(214) 398-1234
(866) 610-0446
Mailing address
PO BOX 172198, DALLAS, TX 75217-1108
(214) 398-1234
(866) 610-0446
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346978376
—
TX
05
—
1477937167
—
TX
05
—
1497443980
—
TX
Enumeration date
09/28/2023
Last updated
09/28/2023
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