Groesbeck Dentist PLLC
Organization Active NPI Dentist · Groesbeck, TX
NPI 1326420779 · NPPES record last updated Jun 22, 2015
Key facts
- NPI
- 1326420779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 22841 (TX)
- Legal business name
- GROESBECK DENTIST PLLC
- Practice address
- 902 W Yeagua St
Groesbeck, TX 76642-3526 - Phone
- (254) 729-8400
- Fax
- (254) 729-8407
- NPI assigned
- Jun 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael Stevens, DDS
- Title
- President
- Phone
- (254) 729-8400
National Provider Directory
Locations
902 W Yeagua St
Groesbeck, TX 76642
Phone (254) 729-8400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 22841 | TX | Yes |
Addresses
Primary practice location
902 W Yeagua St
Groesbeck, TX 76642-3526
Mailing address
902 W Yeagua St
Groesbeck, TX 76642-3526
Phone (254) 729-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2924334-01 | Medicaid | TX |
Other names
- Stevens Dental
Other providers in Groesbeck, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.