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General NPI Number Information
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NPI Number | 1316490832
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Entity Type | Organization
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Legal Business Name | PLEASANT GROVE FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 4330 MCKNIGHT RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0923
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Country | US
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Telephone | 903-838-9700
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Fax | 903-832-3505
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Provider Business Mailing Address
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Address Line | 4330 MCKNIGHT RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0923
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Country | US
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Telephone | 903-838-9700
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Fax | 903-832-3505
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TORIN MICHAEL MARRACINO
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Credential | DDS
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Telephone | 903-733-3390
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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 | 31840
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License Number State | TX
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