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General NPI Number Information
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NPI Number | 1073386900
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Entity Type | Organization
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Legal Business Name | ROCKWALL DENTAL PROFESSIONALS
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 1375 RIDGE RD
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City | ROCKWALL
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State | TX
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Zip | 75087-4243
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Country | US
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Telephone | 972-771-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 RIDGE RD
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City | ROCKWALL
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State | TX
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Zip | 75087-4243
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Country | US
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Telephone | 972-771-4100
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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 | BRIGETTE NICOLE KOETTER
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Credential | DDS
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Telephone | 972-771-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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