Provider Demographics
NPI:1306134101
Name:ADVANCED DENTAL
Entity type:Organization
Organization Name:ADVANCED DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-735-8146
Mailing Address - Street 1:1860 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2808
Mailing Address - Country:US
Mailing Address - Phone:409-735-8146
Mailing Address - Fax:409-735-2167
Practice Address - Street 1:1860 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2808
Practice Address - Country:US
Practice Address - Phone:409-735-8146
Practice Address - Fax:409-735-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty