Healthcare Provider Details

I. General information

NPI: 1699437954
Provider Name (Legal Business Name): TOWN EAST RR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N TOWN EAST BLVD STE 100
MESQUITE TX
75150-4100
US

IV. Provider business mailing address

1831 BENNETT AVE APT C
DALLAS TX
75206-7545
US

V. Phone/Fax

Practice location:
  • Phone: 469-885-7969
  • Fax:
Mailing address:
  • Phone: 214-534-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NEMESIO RODRIGUEZ JR.
Title or Position: OWNER
Credential: DDS
Phone: 214-534-5432