Provider Demographics
NPI:1144700394
Name:PURE DENTAL ORAL SURGERY PLLC
Entity type:Organization
Organization Name:PURE DENTAL ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIELD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-550-5051
Mailing Address - Street 1:3201 W AIRPORT FWY STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5928
Mailing Address - Country:US
Mailing Address - Phone:972-893-8730
Mailing Address - Fax:972-893-6582
Practice Address - Street 1:5321 E MOCKINGBIRD LN STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-0915
Practice Address - Country:US
Practice Address - Phone:214-550-5051
Practice Address - Fax:214-550-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty