Provider Demographics
NPI:1285422329
Name:PECAN GROVE DENTAL
Entity type:Organization
Organization Name:PECAN GROVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-868-8506
Mailing Address - Street 1:2913 OVERLAND TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4516
Mailing Address - Country:US
Mailing Address - Phone:903-868-8506
Mailing Address - Fax:903-868-9655
Practice Address - Street 1:2913 OVERLAND TRL STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4516
Practice Address - Country:US
Practice Address - Phone:903-868-8506
Practice Address - Fax:903-868-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental