Provider Demographics
NPI:1912769563
Name:TRINITY ENDODONTICS.
Entity Type:Organization
Organization Name:TRINITY ENDODONTICS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:COOKE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:817-361-0929
Mailing Address - Street 1:6700 HARRIS PKWY
Mailing Address - Street 2:TRINITY ENDODONTICS
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-361-0929
Mailing Address - Fax:817-361-0928
Practice Address - Street 1:2214 E US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6010
Practice Address - Country:US
Practice Address - Phone:817-573-1624
Practice Address - Fax:817-573-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty