Provider Demographics
NPI:1528344173
Name:CENTRAL PARK DENTAL
Entity type:Organization
Organization Name:CENTRAL PARK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-466-1200
Mailing Address - Street 1:3101 S. CENTER ST.
Mailing Address - Street 2:SUITE #151
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014
Mailing Address - Country:US
Mailing Address - Phone:817-466-1200
Mailing Address - Fax:817-466-1201
Practice Address - Street 1:3101 S. CENTER ST
Practice Address - Street 2:SUITE #151
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-466-1200
Practice Address - Fax:817-466-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty