Provider Demographics
NPI:1588684351
Name:POWELL AND RECORD, DDS, PLLC
Entity Type:Organization
Organization Name:POWELL AND RECORD, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-665-4761
Mailing Address - Street 1:212 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-5013
Mailing Address - Country:US
Mailing Address - Phone:940-665-4761
Mailing Address - Fax:940-665-0199
Practice Address - Street 1:212 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-5013
Practice Address - Country:US
Practice Address - Phone:940-665-4761
Practice Address - Fax:940-665-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty