Provider Demographics
NPI:1952742470
Name:ENDODONTIC SPECIALISTS OF ROCKWALL BAMF DENTAL PLLC SOLE MBR
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALISTS OF ROCKWALL BAMF DENTAL PLLC SOLE MBR
Other - Org Name:ENDODONTIC SPECIALIST OF ROCKWALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-529-8151
Mailing Address - Street 1:1215 ARISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6657
Mailing Address - Country:US
Mailing Address - Phone:469-698-7668
Mailing Address - Fax:469-698-7670
Practice Address - Street 1:1215 ARISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6657
Practice Address - Country:US
Practice Address - Phone:469-698-7668
Practice Address - Fax:469-698-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238111223E0200X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty