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General NPI Number Information
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NPI Number | 1417594557
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Entity Type | Organization
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Legal Business Name | ACRE WOOD DENTAL - TEMPLE PA
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 5519 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-7422
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Country | US
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Telephone | 254-778-4951
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Fax |
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Provider Business Mailing Address
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Address Line | 5519 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-7422
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Country | US
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Telephone | 254-778-4951
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Fax | 254-778-4199
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KISHA L FUENTES
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Credential |
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Telephone | 254-778-4951
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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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