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General NPI Number Information
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NPI Number | 1730484734
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Entity Type | Organization
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Legal Business Name | ARCHSTONE DENTAL-GRANBURY PLLC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 301 E HIGHWAY 377 SUITE 100
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City | GRANBURY
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State | TX
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Zip | 76048-1200
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Country | US
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Telephone | 972-869-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 STATE HIGHWAY 161 STE 198
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City | IRVING
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State | TX
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Zip | 75039-2880
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Country | US
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Telephone | 972-869-3789
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARY PU
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Credential |
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Telephone | 972-869-3789
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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 |
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License Number State |
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