Provider Demographics
NPI:1659655199
Name:FAMILY TREE DENTAL GROUP
Entity Type:Organization
Organization Name:FAMILY TREE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:RHETT
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-458-5999
Mailing Address - Street 1:5310 BURNET ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-458-5999
Mailing Address - Fax:512-355-1291
Practice Address - Street 1:5310 BURNET RD
Practice Address - Street 2:SUITE 108
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2003
Practice Address - Country:US
Practice Address - Phone:512-458-5999
Practice Address - Fax:512-355-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty