Provider Demographics
NPI:1811380710
Name:FAMILY TREE DENTAL GROUP TWO PLLC
Entity Type:Organization
Organization Name:FAMILY TREE DENTAL GROUP TWO PLLC
Other - Org Name:FAMILY TREE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-458-5999
Mailing Address - Street 1:1008 MOPAC CIRCLE
Mailing Address - Street 2:UNITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:513-458-5999
Mailing Address - Fax:512-428-4013
Practice Address - Street 1:1008 MOPAC CIRCLE
Practice Address - Street 2:UNITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:513-458-5999
Practice Address - Fax:512-428-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty