Provider Demographics
NPI:1538310248
Name:MILL FOREST DENTAL GROUP
Entity Type:Organization
Organization Name:MILL FOREST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-204-8100
Mailing Address - Street 1:17240 MILL FOREST LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-204-8100
Mailing Address - Fax:281-204-8104
Practice Address - Street 1:17240 MILL FOREST RD
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4370
Practice Address - Country:US
Practice Address - Phone:281-204-8100
Practice Address - Fax:281-204-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151211223G0001X
TX209921223G0001X
TX218401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty