EAST LAKE DENTAL PLLC NPI 1568992261

NPI Information

NPI: 1568992261
Provider Name: EAST LAKE DENTAL, PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
718 N BUCKNER BLVD STE 110
DALLAS, TX
ZIP 75218
Phone: (214) 295-8440
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EAST LAKE DENTAL, PLLC is a dental clinic center in Dallas, TX. EAST LAKE DENTAL, PLLC NPI is 1568992261. The provider is registered as an organization entity type.

The provider's business location address is:

718 N BUCKNER BLVD STE 110
DALLAS, TX
ZIP 75218-764
Phone: (214) 295-8440

The provider's authorized official is Brent Steven Desutter .
The authorized official title is Dentist and has the following contact phone number (972) 559-4185.

The enumeration date for this NPI number is 6/14/2017 and was last updated on 10/10/2017.

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
1	261QD0000X	Clinic/Center	Dental			Yes

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: 11/14/2023

NPI Synchronization or Removal

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