Provider Demographics
NPI:1083145460
Name:DAMON DENTAL AND IMPLANT CENTER, PLLC
Entity Type:Organization
Organization Name:DAMON DENTAL AND IMPLANT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-584-7991
Mailing Address - Street 1:100 N CENTRAL EXPY STE 130
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5332
Mailing Address - Country:US
Mailing Address - Phone:972-808-6008
Mailing Address - Fax:972-808-6009
Practice Address - Street 1:100 N CENTRAL EXPY STE 130
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5332
Practice Address - Country:US
Practice Address - Phone:972-808-6008
Practice Address - Fax:972-808-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27147122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty