Provider Demographics
NPI:1902228257
Name:16:3 DENTAL, PC
Entity Type:Organization
Organization Name:16:3 DENTAL, PC
Other - Org Name:TRU DENTAL, LIMESTONE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-848-9566
Mailing Address - Street 1:27487 W HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-3717
Mailing Address - Country:US
Mailing Address - Phone:254-848-9566
Mailing Address - Fax:
Practice Address - Street 1:513 E YEAGUA ST
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-1578
Practice Address - Country:US
Practice Address - Phone:254-255-4071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25535261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental