Provider Demographics
NPI:1508152356
Name:FAMILY DENTAL CARE OF GAINESVILLE, PLLC
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF GAINESVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-781-9680
Mailing Address - Street 1:117 CRYSTAL BROOKE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8238
Mailing Address - Country:US
Mailing Address - Phone:940-665-4211
Mailing Address - Fax:940-665-9581
Practice Address - Street 1:112 N DENTON ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4158
Practice Address - Country:US
Practice Address - Phone:940-665-4211
Practice Address - Fax:940-665-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24498261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental