| Custom Dental Of Carrollton, Pllc | |
|
17610 Midway Rd Ste 110 Dallas TX 75287-6741 | |
| (405) 227-6100 | |
| Not Available |
| Full Name | Custom Dental Of Carrollton, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 17610 Midway Rd Ste 110, Dallas, Texas |
| Authorized Official Name and Position | Rene Rodgers (COO) |
| Authorized Official Contact | 4052276100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Dental Of Carrollton, Pllc 17610 Midway Rd Ste 110 Dallas TX 75287-6741 Ph: (405) 227-6100 | Custom Dental Of Carrollton, Pllc 17610 Midway Rd Ste 110 Dallas TX 75287-6741 Ph: (405) 227-6100 |
| NPI Number | 1366924383 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 09/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366924383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 26171 (Texas) | Primary |
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