Provider Demographics
NPI:1346757960
Name:MABRY AND CONIGLIO DENTISTRY
Entity Type:Organization
Organization Name:MABRY AND CONIGLIO DENTISTRY
Other - Org Name:MICHAEL MABRY DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-329-6677
Mailing Address - Street 1:271 E SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6272
Mailing Address - Country:US
Mailing Address - Phone:817-329-6677
Mailing Address - Fax:817-488-4995
Practice Address - Street 1:271 E SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6272
Practice Address - Country:US
Practice Address - Phone:817-329-6677
Practice Address - Fax:817-488-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10892261QD0000X
TX24577261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568500197OtherDENTAL
TX1639307051OtherDENTAL