Provider Demographics
NPI:1467573410
Name:ROWLETT DENTAL ASSOC LLP
Entity Type:Organization
Organization Name:ROWLETT DENTAL ASSOC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:BAY
Authorized Official - Last Name:DANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-475-0301
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-1490
Mailing Address - Country:US
Mailing Address - Phone:972-475-0301
Mailing Address - Fax:972-463-3849
Practice Address - Street 1:4518 ROWLETT RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5081
Practice Address - Country:US
Practice Address - Phone:972-475-0301
Practice Address - Fax:972-463-3849
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 Licenses
StateLicense IDTaxonomies
TX125571223G0001X
TX167051223G0001X
TX172261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty