| Custom Dental Of The Colony, Pllc | |
|
4695 N Colony Blvd Ste 104 The Colony TX 75056-3330 | |
| (972) 625-0213 | |
| Not Available |
| Full Name | Custom Dental Of The Colony, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4695 N Colony Blvd Ste 104, The Colony, 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 The Colony, Pllc 4695 N Colony Blvd Ste 104 The Colony TX 75056-3330 Ph: (972) 625-0213 | Custom Dental Of The Colony, Pllc 4695 N Colony Blvd Ste 104 The Colony TX 75056-3330 Ph: (972) 625-0213 |
| NPI Number | 1568123719 |
|---|---|
| Provider Enumeration Date | 01/09/2022 |
| Last Update Date | 01/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568123719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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