Provider Demographics
NPI:1295860534
Name:SOMERSET DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:SOMERSET DENTAL GROUP PLLC
Other - Org Name:FAMILY CHOICE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-227-0101
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:TX
Mailing Address - Zip Code:78069
Mailing Address - Country:US
Mailing Address - Phone:830-429-3000
Mailing Address - Fax:830-429-3005
Practice Address - Street 1:19585 K STREET
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:TX
Practice Address - Zip Code:78069
Practice Address - Country:US
Practice Address - Phone:830-429-3000
Practice Address - Fax:830-429-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16271122300000X
TX10761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty