Fresh Dental-Shreveport

NPI #1073880639 in Irving, Texas

Provider Information

NPI Number: 1073880639
Entity Type: Organization
Organization Name: Fresh Dental-Shreveport
Primary Specialty: Dentist
Enumeration Date: Nov 28, 2011
Last Updated: Nov 28, 2011

Practice Location

Address: 7301 STATE HIGHWAY 161 STE 198
City: Irving
State: Texas
ZIP Code: 75039-2880
Phone: (972) 869-3789

Authorized Official

Name: MARY PU
Title: VP OF FINANCE
Phone: (972) 869-3789

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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