MEDICARE: APG DENTAL, PA

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1609472976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APG DENTAL, PA

Provider Business Mailing Address
First Line	:	639 KINNEY DR
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-3318
Country	:	US
Telephone Number	:	972-824-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 MCDERMOTT RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-4613
Country	:	US
Telephone Number	:	214-256-7330
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST, CORPORATE OWNER
Name	:	DR. ANDREA PILAR GONZALES
Credential	:	DDS, MS
Telephone Number	:	972-824-5850

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	04/19/2022

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