| NPI | 1942338546 |
|---|---|
| Former Legal Business Name | HARGROVE DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | AUTUMN BELLE DENSMAN Dental Assistant Adminstrative Off 979-776-4364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 16734) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 9539) |
| 1223P0300X Dentist, Periodontics (Licence: TX 16730) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 4696) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |