Provider Demographics
NPI:1255595096
Name:PRINCETON FAMILY DENTAL
Entity type:Organization
Organization Name:PRINCETON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-734-3336
Mailing Address - Street 1:275 W PRINCETON DR
Mailing Address - Street 2:# 100
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-9602
Mailing Address - Country:US
Mailing Address - Phone:972-734-3336
Mailing Address - Fax:469-519-0163
Practice Address - Street 1:275 W PRINCETON DR
Practice Address - Street 2:# 100
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9602
Practice Address - Country:US
Practice Address - Phone:972-734-3336
Practice Address - Fax:469-519-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty