Provider Demographics
NPI:1033466073
Name:FAMILY TOTAL DENTAL, PA
Entity Type:Organization
Organization Name:FAMILY TOTAL DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-285-9685
Mailing Address - Street 1:910 W 11TH ST
Mailing Address - Street 2:#260
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-2042
Mailing Address - Country:US
Mailing Address - Phone:512-285-9685
Mailing Address - Fax:512-352-1516
Practice Address - Street 1:910 W 11TH ST
Practice Address - Street 2:#260
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2042
Practice Address - Country:US
Practice Address - Phone:512-285-9685
Practice Address - Fax:512-352-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty