Provider Demographics
NPI:1679262083
Name:FANCHER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FANCHER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-532-5645
Mailing Address - Street 1:215 S RAGSDALE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4933
Mailing Address - Country:US
Mailing Address - Phone:903-485-5557
Mailing Address - Fax:903-206-8088
Practice Address - Street 1:215 S RAGSDALE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4933
Practice Address - Country:US
Practice Address - Phone:903-485-5557
Practice Address - Fax:903-206-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental