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610 Old Campbell Rd Ste 116 Richardson TX 75080-3379 | |
(972) 231-2576 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 610 Old Campbell Rd Ste 116, Richardson, Texas |
Authorized Official Name and Position | Dale Bryan Countryman (OWNER) |
Authorized Official Contact | 8173087079 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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610 Old Campbell Rd Ste 116 Richardson TX 75080-3379 Ph: (972) 231-2576 | 610 Old Campbell Rd Ste 116 Richardson TX 75080-3379 Ph: (972) 231-2576 |
NPI Number | 1326564295 |
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Provider Enumeration Date | 08/22/2017 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326564295 | NPI | - | NPPES |
1326254772 | Other | TX | GENERAL |
1417203407 | Other | TX | GENERAL |
1053576447 | Other | TX | GENERAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Richardson Oral Surgery And Implant Center Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1070 W Campbell Rd, Suite 200, Richardson, TX 75080 Phone: 972-231-6661 Fax: 972-231-3161 | |
Jay L. Nutt & C. Fred Pietsch, Dds, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1231 E Belt Line Rd, Suite 103, Richardson, TX 75081 Phone: 972-690-8617 Fax: 972-690-6423 | |