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General NPI Number Information
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NPI Number | 1831002724
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Entity Type | Organization
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Legal Business Name | PRIMROSE DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 3522 DENTON HWY
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City | HALTOM CITY
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State | TX
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Zip | 76117-3210
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Country | US
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Telephone | 817-918-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 VILLAGE PKWY STE 120
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-3285
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACKSON FULLER
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Credential | DDS
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Telephone | 208-206-9375
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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 |
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License Number State |
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