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General NPI Number Information
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NPI Number | 1942910351
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Entity Type | Organization
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Legal Business Name | 380 FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1361 E UNIVERSITY DR STE 10
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City | PROSPER
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State | TX
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Zip | 75078-7265
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Country | US
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Telephone | 972-533-2458
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Fax |
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Provider Business Mailing Address
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Address Line | 1361 E UNIVERSITY DR STE 10
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City | PROSPER
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State | TX
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Zip | 75078-7265
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Country | US
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Telephone | 972-533-2458
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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. TRAVIS MCKAY CAMPBELL
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Credential | DDS
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Telephone | 972-533-2458
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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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