=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174075212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J ERIC FRANCOM D.M.D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2016
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 AVALON DR
-----------------------------------------------------
City | SEAGOVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75159-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-287-5513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 AVALON DRIVE
-----------------------------------------------------
City | SEAGOVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-287-5513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN ERIC FRANCOM
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 972-287-5513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 29699
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------