Provider Demographics
NPI:1144989484
Name:SIMPLE DENTAL PLLC
Entity type:Organization
Organization Name:SIMPLE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-928-5659
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1012 S CROWLEY RD STE C
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3664
Practice Address - Country:US
Practice Address - Phone:817-928-5659
Practice Address - Fax:817-241-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental