Provider Demographics
NPI:1295839884
Name:PROGRESSIVE DENTAL CENTER PC
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL CENTER PC
Other - Org Name:STONEWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-662-3306
Mailing Address - Street 1:421 N ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706
Mailing Address - Country:US
Mailing Address - Phone:254-662-3306
Mailing Address - Fax:254-662-2500
Practice Address - Street 1:421 N ROBINSON DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706
Practice Address - Country:US
Practice Address - Phone:254-662-3306
Practice Address - Fax:254-662-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty