NPI 1003351271

Glen Rose Family Dental

Organisation Preferred Provider Organization Glen Rose, TX

Practice location

Address: 1104 Bluebonnet St, Glen Rose, TX 76043-5013
Phone: (254) 898-4646
Fax: (254) 897-7321

Authorised official

Name: Clayton K Cook
Title: General Dentist
Phone: (254) 898-4646

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 29154 (TX)

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Registry record

NPI: 1003351271
Entity type: Organization
NPI issued: 27 Dec 2016
Record last updated: 27 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.