Provider Demographics
NPI:1003267212
Name:MENO GROUP, PLLC
Entity Type:Organization
Organization Name:MENO GROUP, PLLC
Other - Org Name:KILGORE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY-PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-984-1108
Mailing Address - Street 1:1806 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3520
Mailing Address - Country:US
Mailing Address - Phone:903-984-1108
Mailing Address - Fax:903-984-1107
Practice Address - Street 1:1806 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3520
Practice Address - Country:US
Practice Address - Phone:903-984-1108
Practice Address - Fax:903-984-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty