Provider Demographics
NPI:1942017462
Name:AFFORDABLE DENTIST NEAR ME OF MANSFIELD PLLC
Entity type:Organization
Organization Name:AFFORDABLE DENTIST NEAR ME OF MANSFIELD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-441-1558
Mailing Address - Street 1:708 HUNTERS ROW CT STE 102
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:708 HUNTERS ROW CT STE 102
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4018
Practice Address - Country:US
Practice Address - Phone:713-894-4059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty