Longevity Dental
Clinic/Center, Dental in Rockwall, TX. Organization (NPI-2).
NPI number1669989240
StatusActive
Last updated in NPPESJan 5, 2018
Details
- NPI
- 1669989240
- Entity type
- Organization (NPI-2)
- Legal business name
- Longevity Dental
- Organization subpart
- No
- Enumeration date
- Jan 5, 2018
- Last updated
- Jan 5, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | 17186 | TX | Yes |
Practice location
510 Turtle Cove Blvd Ste 107Rockwall, TX 75087-5374
Phone 972-771-0977
Mailing address
510 Turtle Cove Blvd Ste 107Rockwall, TX 75087-5374
Authorized official
Ronald G Evans
Sole Mbr
9727710977
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