Provider Demographics
NPI:1821713181
Name:PEDIATRIC DENTISTRY OF DENTON PLLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF DENTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-408-1057
Mailing Address - Street 1:2185 BRINKER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6999
Mailing Address - Country:US
Mailing Address - Phone:940-222-4589
Mailing Address - Fax:
Practice Address - Street 1:2185 BRINKER RD STE 110
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6999
Practice Address - Country:US
Practice Address - Phone:940-222-4589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty