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General NPI Number Information
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NPI Number | 1225832983
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Entity Type | Organization
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Legal Business Name | CUSTOM DENTAL OF GAINESVILLE PLLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 301 E CALIFORNIA ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-4005
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Country | US
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Telephone | 940-665-0726
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E CALIFORNIA ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-4005
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Country | US
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Telephone | 940-665-0726
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Fax |
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Authorized Official
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Title or Position | DR-OWNER
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Name | DR. BRYCE GATES
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Credential | DDS
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Telephone | 214-616-1574
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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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