Healthcare Provider Details

I. General information

NPI: 1033694187
Provider Name (Legal Business Name): RGT DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SIMONTON ST. SUITE 100
CONROE TX
77301
US

IV. Provider business mailing address

402 SIMONTON ST. SUITE 100
CONROE TX
77301
US

V. Phone/Fax

Practice location:
  • Phone: 936-441-4455
  • Fax: 888-678-1441
Mailing address:
  • Phone: 936-441-4455
  • Fax: 888-678-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO K. GILES
Title or Position: OWNER
Credential: DMD
Phone: 936-441-4455