Provider Demographics
NPI:1669928073
Name:ROUND GROVE FAMILY DENTISTRY
Entity type:Organization
Organization Name:ROUND GROVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-218-5917
Mailing Address - Street 1:1901 NORTHWEST HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 S STEMMONS FWY
Practice Address - Street 2:STE 301
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8754
Practice Address - Country:US
Practice Address - Phone:469-556-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty