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General NPI Number Information
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NPI Number | 1265267520
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Entity Type | Organization
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Legal Business Name | SALT CREEK DENTAL, PLLC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 901 AUSTIN RD
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City | GRAHAM
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State | TX
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Zip | 76450-4214
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Country | US
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Telephone | 940-549-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 E BROADWAY ST
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City | BROWNFIELD
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State | TX
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Zip | 79316-4802
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Country | US
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Telephone | 806-241-3812
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARRETT EMIL CHAPPELL
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Credential | DDS
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Telephone | 806-241-3812
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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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