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General NPI Number Information
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NPI Number | 1720466568
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Entity Type | Organization
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Legal Business Name | GAINESVILLE SMILES
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 411 W CALIFORNIA ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-3907
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Country | US
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Telephone | 940-665-1571
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Fax |
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Provider Business Mailing Address
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Address Line | 411 W CALIFORNIA ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-3907
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Country | US
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Telephone | 940-665-1571
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DALLIN ROLAND PALMER
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Credential | DMD
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Telephone | 940-665-1571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30182
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License Number State | TX
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