Provider Demographics
NPI:1811387996
Name:GRAND PARKWAY DENTAL PLLC
Entity Type:Organization
Organization Name:GRAND PARKWAY DENTAL PLLC
Other - Org Name:GRAND PARKWAY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-222-0016
Mailing Address - Street 1:2004 S MASON RD STE B3
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6252
Mailing Address - Country:US
Mailing Address - Phone:832-222-0016
Mailing Address - Fax:832-559-0772
Practice Address - Street 1:2004 S MASON RD STE B3
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6252
Practice Address - Country:US
Practice Address - Phone:832-222-0016
Practice Address - Fax:832-201-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty