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General NPI Number Information
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NPI Number | 1508645326
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Entity Type | Organization
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Legal Business Name | PEARL DENTURES AND DENTAL CARE, PLLC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 915 W. PEARL ST.
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City | GRANBURY
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State | TX
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Zip | 76048
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Country | US
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Telephone | 817-579-7297
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Fax | 817-579-9588
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Provider Business Mailing Address
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Address Line | 915 W. PEARL ST.
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City | GRANBURY
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State | TX
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Zip | 76048
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Country | US
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Telephone | 817-579-7297
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Fax | 817-579-9588
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DONNA DENISE GARRETT-SMITH
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Credential |
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Telephone | 817-579-7297
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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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