Provider Demographics
NPI:1831789387
Name:FORT BEND DENTAL GRAND PARKWAY, PLLC
Entity type:Organization
Organization Name:FORT BEND DENTAL GRAND PARKWAY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:PECCORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-499-3541
Mailing Address - Street 1:7417 W GRAND PARKWAY S
Mailing Address - Street 2:STE 140
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:281-232-8300
Mailing Address - Fax:
Practice Address - Street 1:7417 W GRAND PARKWAY S
Practice Address - Street 2:STE 140
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:281-232-8300
Practice Address - Fax:281-605-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty