Provider Demographics
NPI:1205512704
Name:TUSK DENTAL GROUP INC
Entity type:Organization
Organization Name:TUSK DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-882-6874
Mailing Address - Street 1:1901 POST OAK BLVD
Mailing Address - Street 2:#2108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056
Mailing Address - Country:US
Mailing Address - Phone:214-882-6874
Mailing Address - Fax:214-276-7500
Practice Address - Street 1:11625 BROADWAY ST STE 185
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3937
Practice Address - Country:US
Practice Address - Phone:713-955-4224
Practice Address - Fax:713-955-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No126900000XDental ProvidersDental Laboratory TechnicianGroup - Multi-Specialty