Provider Demographics
NPI:1689098303
Name:CONROE FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:CONROE FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-539-2211
Mailing Address - Street 1:1362 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2146
Mailing Address - Country:US
Mailing Address - Phone:936-539-2211
Mailing Address - Fax:936-539-2216
Practice Address - Street 1:1362 WILSON RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2146
Practice Address - Country:US
Practice Address - Phone:936-539-2211
Practice Address - Fax:936-539-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty