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General NPI Number Information
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NPI Number | 1992063218
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Entity Type | Organization
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Legal Business Name | CADDELL FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 501 CLIFF DR
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City | GRAHAM
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State | TX
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Zip | 76450-3327
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Country | US
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Telephone | 940-549-6092
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Fax | 940-549-3970
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Provider Business Mailing Address
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Address Line | 501 CLIFF DR
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City | GRAHAM
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State | TX
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Zip | 76450-3327
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Country | US
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Telephone | 940-549-6092
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Fax | 940-549-3970
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. TRAVIS GLENN CADDELL
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Credential | D.D.S.
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Telephone | 940-549-6092
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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 | 12625
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22825
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License Number State | TX
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