Provider Demographics
NPI:1649590290
Name:RIGBY ADVANCED DENTAL LLC
Entity Type:Organization
Organization Name:RIGBY ADVANCED DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-876-0573
Mailing Address - Street 1:12912 HILL COUNTRY BLVD
Mailing Address - Street 2:BUILDING F, SUITE 205
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12912 HILL COUNTRY BLVD
Practice Address - Street 2:BUILDING F, SUITE 205
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6328
Practice Address - Country:US
Practice Address - Phone:817-876-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244601223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty