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General NPI Number Information
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NPI Number | 1902289143
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Entity Type | Organization
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Legal Business Name | GRANDBURY DENTAL , PLLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 708 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-2396
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Country | US
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Telephone | 817-573-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 E MCKINNEY ST 100
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City | DENTON
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State | TX
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Zip | 76209-7557
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Country | US
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Telephone | 940-808-1970
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Fax |
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Authorized Official
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Title or Position | DDS, OWNER
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Name | EVERETT C EVANS
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Credential |
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Telephone | 940-808-1970
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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 | 23695
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License Number State | TX
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