| The Grand Family Dental | |
|
1620 Grand Avenue Pkwy Ste 130 Pflugerville TX 78660-2185 | |
| (512) 670-8482 | |
| Not Available |
| Full Name | The Grand Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 1620 Grand Avenue Pkwy Ste 130, Pflugerville, Texas |
| Authorized Official Name and Position | Laresea Woods (DENTIST/PART-OWNER) |
| Authorized Official Contact | 3345904223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Grand Family Dental 1620 Grand Avenue Pkwy Ste 130 Pflugerville TX 78660-2185 Ph: (512) 670-8482 | The Grand Family Dental 1620 Grand Avenue Pkwy Ste 130 Pflugerville TX 78660-2185 Ph: (512) 670-8482 |
| NPI Number | 1154955805 |
|---|---|
| Provider Enumeration Date | 03/02/2020 |
| Last Update Date | 04/09/2020 |
| Medicare PECOS PAC ID | 6901222371 |
|---|---|
| Medicare Enrollment ID | O20200717001130 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154955805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Laresea Woods |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1568777654 PECOS PAC ID: 7214211564 Enrollment ID: I20200814002764 |
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