Healthcare Provider Details

I. General information

NPI: 1619249208
Provider Name (Legal Business Name): JARRELL FAMILY DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TOWN CENTER BLVD 100
JARRELL TX
76537
US

IV. Provider business mailing address

400 DEL WEBB BLVD 104
GEORGETOWN TX
78633-4354
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-5000
  • Fax:
Mailing address:
  • Phone: 512-868-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23130
License Number StateTX

VIII. Authorized Official

Name: PATRICK BELL
Title or Position: OWNER
Credential: DDS
Phone: 512-868-5000