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General NPI Number Information
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NPI Number | 1346757960
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Entity Type | Organization
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Legal Business Name | MABRY AND CONIGLIO DENTISTRY
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 271 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6272
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Country | US
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Telephone | 817-329-6677
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Fax | 817-488-4995
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Provider Business Mailing Address
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Address Line | 271 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6272
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Country | US
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Telephone | 817-329-6677
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Fax | 817-488-4995
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | MELINDA BRITTON
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Credential |
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Telephone | 817-329-6677
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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 | 10892
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 24577
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License Number State | TX
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