Provider Demographics
NPI:1649529801
Name:ED MCELROY, III DDS PC
Entity type:Organization
Organization Name:ED MCELROY, III DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-328-6659
Mailing Address - Street 1:2121 HERITAGE PKWY
Mailing Address - Street 2:STE F
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3165
Mailing Address - Country:US
Mailing Address - Phone:903-328-6659
Mailing Address - Fax:903-328-6661
Practice Address - Street 1:2121 HERITAGE PKWY
Practice Address - Street 2:STE F
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3165
Practice Address - Country:US
Practice Address - Phone:903-328-6659
Practice Address - Fax:903-328-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6717600001Medicare NSC