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General NPI Number Information
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NPI Number | 1942687264
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Entity Type | Organization
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Legal Business Name | GBCC DENTAL PLLC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 104 SPANISH OAKS TRAIL
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City | GLEN ROSE
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State | TX
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Zip | 76043
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Country | US
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Telephone | 254-897-3143
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Fax | 903-465-1134
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Provider Business Mailing Address
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Address Line | 104 SPANISH OAKS TRAIL
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City | GLEN ROSE
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State | TX
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Zip | 76043
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Country | US
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Telephone | 254-897-3143
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Fax | 903-465-1134
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. CLAYTON K COOK
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Credential | DMD
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Telephone | 817-294-1090
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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 | 29154
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License Number State | TX
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