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General NPI Number Information
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NPI Number | 1710540232
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Entity Type | Organization
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Legal Business Name | GROESBECK FAMILY DENTAL
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 902 W YEAGUA ST
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City | GROESBECK
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State | TX
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Zip | 76642-3526
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Country | US
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Telephone | 254-729-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 17480 DALLAS PKWY STE 213
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City | DALLAS
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State | TX
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Zip | 75287-7304
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Country | US
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Telephone | 972-248-1221
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM ROBERT JENNINGS JR.
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Credential | DDS
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Telephone | 940-206-8956
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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 |
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License Number State |
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