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General NPI Number Information
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NPI Number | 1326276205
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Entity Type | Organization
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Legal Business Name | COMFORT DENTAL CLAY MATHIS, PLLC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 540 CLAY MATHIS RD 110
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City | MESQUITE
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State | TX
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Zip | 75181-1167
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Country | US
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Telephone | 972-222-5313
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Fax |
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Provider Business Mailing Address
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Address Line | 540 CLAY MATHIS RD 110
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City | MESQUITE
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State | TX
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Zip | 75181-1167
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Country | US
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Telephone | 972-222-5313
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JEREMY BULLOCK
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Credential | DMD
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Telephone | 972-222-5313
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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 | 24312
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License Number State | TX
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