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General NPI Number Information
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NPI Number | 1225675366
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Entity Type | Organization
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Legal Business Name | ACRE WOOD DENTAL - GATESVILLE PA
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 105 N LUTTERLOH AVE
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City | GATESVILLE
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State | TX
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Zip | 76528-1421
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Country | US
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Telephone | 254-865-7918
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Fax | 254-248-0529
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Provider Business Mailing Address
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Address Line | 105 N LUTTERLOH AVE
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City | GATESVILLE
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State | TX
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Zip | 76528-1421
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Country | US
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Telephone | 254-865-7918
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Fax | 254-248-0529
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KISHA L FUENTES
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Credential |
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Telephone | 254-778-4951
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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 |
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License Number State |
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