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General NPI Number Information
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NPI Number | 1003342510
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Entity Type | Organization
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Legal Business Name | HEREFORD DENTAL PLLC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 701 N 25 MILE AVE 110
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City | HEREFORD
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State | TX
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Zip | 79045-3054
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Country | US
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Telephone | 806-363-6690
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N 25 MILE AVE 110
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City | HEREFORD
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State | TX
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Zip | 79045-3054
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Country | US
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Telephone | 806-363-6690
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | GUNJAN DHIR
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Credential |
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Telephone | 806-363-6690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24348
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License Number State | TX
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