Provider Demographics
NPI:1861718934
Name:KATY TRAIL DENTAL PLLC
Entity type:Organization
Organization Name:KATY TRAIL DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-455-2942
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:972-248-1221
Mailing Address - Fax:972-248-1072
Practice Address - Street 1:4152 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-7813
Practice Address - Country:US
Practice Address - Phone:214-520-1112
Practice Address - Fax:214-520-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty