Healthcare Provider Details

I. General information

NPI: 1720188758
Provider Name (Legal Business Name): REX EATMON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PARKWAY SUITE 101
DALLAS TX
75234
US

IV. Provider business mailing address

6065 STAR TRAIL DR
FRISCO TX
75034
US

V. Phone/Fax

Practice location:
  • Phone: 972-243-5035
  • Fax: 972-243-8574
Mailing address:
  • Phone: 972-731-7422
  • Fax: 972-768-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08875
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number190
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: