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General NPI Number Information
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NPI Number | 1801256797
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Entity Type | Organization
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Legal Business Name | WAXAHACHIE FAMILY DENTISTRY, LLP
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 125 PARK PLACE BLVD
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City | WAXAHACHIE
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State | TX
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Zip | 75165-9106
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Country | US
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Telephone | 972-937-4370
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Fax | 972-937-4369
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Provider Business Mailing Address
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Address Line | 125 PARK PLACE BLVD
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City | WAXAHACHIE
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State | TX
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Zip | 75165-9106
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Country | US
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Telephone | 972-937-4370
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Fax | 972-937-4369
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SCOTT CLINTON
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Credential | D.D.S.
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Telephone | 972-937-4370
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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 | 19151
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 19151
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License Number State | TX
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