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General NPI Number Information
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NPI Number | 1972266005
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CARE-LUMBERTON PLLC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 148 COUNTRY LANE DR
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City | LUMBERTON
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State | TX
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Zip | 77657-6802
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Country | US
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Telephone | 409-755-3933
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Fax | 409-227-0678
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Provider Business Mailing Address
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Address Line | 148 COUNTRY LANE DR
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City | LUMBERTON
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State | TX
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Zip | 77657-6802
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Country | US
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Telephone | 409-755-3933
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Fax | 409-227-0678
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 972-869-3789
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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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