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General NPI Number Information
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NPI Number | 1023354255
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Entity Type | Organization
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Legal Business Name | ROSEMEADE PLACE DENTAL CENTER, PLLC
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Dates
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Enumeration Date | 12/15/2012
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Last Update Date | 12/15/2012
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Provider Practice Location Address
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Address Line | 311 COMMERCIAL AVE
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City | ANSON
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State | TX
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Zip | 79501-2009
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Country | US
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Telephone | 469-569-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 2432 JEFFERSON COURT LN # 1422
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City | ARLINGTON
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State | TX
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Zip | 76006-6921
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Country | US
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Telephone | 469-569-2331
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Fax |
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Authorized Official
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Title or Position | CEO, DENTIST
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Name | STEVEN D HINCKLEY
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Credential | DDS
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Telephone | 469-569-2331
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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 | 26524
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License Number State | TX
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