Provider Demographics
NPI:1417078775
Name:FARMERSVILLE DENTAL GROUP
Entity Type:Organization
Organization Name:FARMERSVILLE DENTAL GROUP
Other - Org Name:G F DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-784-8282
Mailing Address - Street 1:1010 AUDEY MURPHY PKWY W
Mailing Address - Street 2:P.O. BOX 526
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-2523
Mailing Address - Country:US
Mailing Address - Phone:972-784-8282
Mailing Address - Fax:972-784-7084
Practice Address - Street 1:1010 AUDEY MURPHY PKWY W
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2523
Practice Address - Country:US
Practice Address - Phone:972-784-8282
Practice Address - Fax:972-784-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty