Healthcare Provider Details

I. General information

NPI: 1104315332
Provider Name (Legal Business Name): COMMERCE DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 LIVE OAK ST
COMMERCE TX
75428-2545
US

IV. Provider business mailing address

3600 E MCKINNEY ST STE 100
DENTON TX
76209-7557
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-7833
  • Fax:
Mailing address:
  • Phone: 940-220-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23695
License Number StateTX

VIII. Authorized Official

Name: EVERETT CHAD EVANS
Title or Position: OWNER
Credential: DDS
Phone: 940-220-7833