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NPI Code Detail

MEDICARE: BRIDGE CITY FAMILY DENTISTRY, PLLC

MEDICARE: BRIDGE CITY FAMILY DENTISTRY, PLLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1649816604
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGE CITY FAMILY DENTISTRY, PLLC
Provider Business Mailing Address
First Line : 5900 BALCONES DR
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4257
Country : US
Telephone Number : 409-735-7109
Fax Number :
Provider Business Practice Location Address
First Line : 2525 TEXAS AVE
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2847
Country : US
Telephone Number : 409-735-7109
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DALLIN GOMEZ
Credential :
Telephone Number : 409-735-7109
Provider Enumeration Date : 11/25/2019
Last Update Date : 11/25/2019

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Directions to “BRIDGE CITY FAMILY DENTISTRY, PLLC ” Practice Location

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