Healthcare Provider Details

I. General information

NPI: 1295823714
Provider Name (Legal Business Name): ELGIN FAMILY DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N HIGHWAY 95
ELGIN TX
78621-1519
US

IV. Provider business mailing address

306 N HIGHWAY 95 P.O. BOX 32
ELGIN TX
78621-1519
US

V. Phone/Fax

Practice location:
  • Phone: 512-285-3322
  • Fax: 512-285-3447
Mailing address:
  • Phone: 512-285-3322
  • Fax: 512-285-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberTX11496
License Number StateTX

VIII. Authorized Official

Name: CARL HERRING
Title or Position: PRESIDENT
Credential: DDS
Phone: 512-285-3322