Provider Demographics
NPI:1861669103
Name:R. DANFORD DOSS, DDS, INC
Entity type:Organization
Organization Name:R. DANFORD DOSS, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DANFORD
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-731-6964
Mailing Address - Street 1:4200 BRYANT IRVIN RD STE 129
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4212
Mailing Address - Country:US
Mailing Address - Phone:817-731-6964
Mailing Address - Fax:817-731-4273
Practice Address - Street 1:4200 BRYANT IRVIN RD STE 129
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-4212
Practice Address - Country:US
Practice Address - Phone:817-731-6964
Practice Address - Fax:817-731-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1842700Medicaid