MEDICARE: DR. JAMES TILLMAN GROGAN JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7939	TX

General Provider Information

NPI Number	:	1265433239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES TILLMAN GROGAN JR. DDS

Provider Business Mailing Address
First Line	:	800 W ELDORADO PKWY
Second Line	:	#124
City	:	LITTLE ELM
State	:	TX
Zip	:	75068
Country	:	US
Telephone Number	:	972-292-3820
Fax Number	:	972-292-3802

Provider Business Practice Location Address
First Line	:	800 W ELDORADO PKWY
Second Line	:	#124
City	:	LITTLE ELM
State	:	TX
Zip	:	75068
Country	:	US
Telephone Number	:	972-292-3820
Fax Number	:	972-292-3802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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