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General NPI Number Information
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NPI Number | 1376041764
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Entity Type | Organization
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Legal Business Name | DAYTON DENTAL PLLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 400 E HIGHWAY 90 STE 402
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City | DAYTON
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State | TX
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Zip | 77535-2630
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Country | US
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Telephone | 936-681-8592
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 W GREEN OAKS BLVD STE 103
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City | ARLINGTON
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State | TX
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Zip | 76013-8349
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Country | US
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Telephone | 940-368-1495
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Fax |
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | MR. DARREN EARL BOGGS
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Credential |
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Telephone | 940-368-1495
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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 | 24348
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License Number State | TX
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