Provider Demographics
NPI:1619313731
Name:AMERICA'S FAMILY DENTAL
Entity Type:Organization
Organization Name:AMERICA'S FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-290-8000
Mailing Address - Street 1:616 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5538
Mailing Address - Country:US
Mailing Address - Phone:281-290-8000
Mailing Address - Fax:281-516-2397
Practice Address - Street 1:616 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5538
Practice Address - Country:US
Practice Address - Phone:281-290-8000
Practice Address - Fax:281-516-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0196861223G0001X
TX209611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154667160OtherDENTAL
TX1760578231OtherDENTAL