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General NPI Number Information
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NPI Number | 1821713181
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF DENTON PLLC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 2185 BRINKER RD STE 110
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City | DENTON
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State | TX
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Zip | 76208-6999
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Country | US
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Telephone | 940-222-4589
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Fax |
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Provider Business Mailing Address
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Address Line | 2185 BRINKER RD STE 110
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City | DENTON
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State | TX
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Zip | 76208-6999
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Country | US
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Telephone | 940-222-4589
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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. REX GIBSON
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Credential | DDS
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Telephone | 541-408-1057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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