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General NPI Number Information
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NPI Number | 1255464343
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Entity Type | Organization
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Legal Business Name | FOREST TRAIL DENTAL CARE
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4206 LOWES DR
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City | TEMPLE
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State | TX
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Zip | 76502-3498
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Country | US
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Telephone | 254-778-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 LOWES DR
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City | TEMPLE
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State | TX
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Zip | 76502-3498
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Country | US
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Telephone | 254-778-5070
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. TERRY S PROCTOR
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Credential | D.D.S.
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Telephone | 254-778-5070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | TX
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