Provider Demographics
NPI:1558534487
Name:BACLIFF DENTAL CLINIC P.A.
Entity Type:Organization
Organization Name:BACLIFF DENTAL CLINIC P.A.
Other - Org Name:BACLIFF DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-559-1531
Mailing Address - Street 1:235 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BACLIFF
Mailing Address - State:TX
Mailing Address - Zip Code:77518-1609
Mailing Address - Country:US
Mailing Address - Phone:281-559-1531
Mailing Address - Fax:281-559-1532
Practice Address - Street 1:235 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BACLIFF
Practice Address - State:TX
Practice Address - Zip Code:77518-1609
Practice Address - Country:US
Practice Address - Phone:281-559-1531
Practice Address - Fax:281-559-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty