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General NPI Number Information
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NPI Number | 1467573410
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Entity Type | Organization
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Legal Business Name | ROWLETT DENTAL ASSOC LLP
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4518 ROWLETT RD
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City | ROWLETT
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State | TX
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Zip | 75088-5081
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Country | US
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Telephone | 972-475-0301
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Fax | 972-463-3849
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Provider Business Mailing Address
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Address Line | PO BOX 1490
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City | ROWLETT
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State | TX
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Zip | 75030-1490
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Country | US
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Telephone | 972-475-0301
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Fax | 972-463-3849
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. BRADLEY BAY DANIER
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Credential | DDS
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Telephone | 972-475-0301
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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 | 16705
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17226
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12557
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License Number State | TX
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