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THE DENTIST OFF MAIN PLLC NPI 1396184693


NPI Information

NPI: 1396184693
Provider Name: THE DENTIST OFF MAIN, PLLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1245 S. MAIN ST.
SUITE 100
GRAPEVINE, TX
ZIP 76051
Phone: (817) 527-1590
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THE DENTIST OFF MAIN, PLLC is a general practice dentist in Grapevine, TX. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. THE DENTIST OFF MAIN, PLLC NPI is 1396184693. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1245 S. MAIN ST.
SUITE 100
GRAPEVINE, TX
ZIP 76051
Phone: (817) 527-1590
Fax: (940) 497-3010

The provider's authorized official is Richard Bernard Luczak .
The authorized official title is Ceo and has the following contact phone number (817) 527-1590.

The enumeration date for this NPI number is 6/19/2013 and was last updated on 6/19/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice19398TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1870515OTHERUNITED CONCORDIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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