Provider Demographics
NPI:1811143597
Name:STAFFORD DENTAL PLLC
Entity type:Organization
Organization Name:STAFFORD DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUSSLEWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-827-8200
Mailing Address - Street 1:11753 W BELLFORT ST
Mailing Address - Street 2:#116
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1327
Mailing Address - Country:US
Mailing Address - Phone:281-561-0726
Mailing Address - Fax:
Practice Address - Street 1:11753 W BELLFORT ST
Practice Address - Street 2:#116
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1327
Practice Address - Country:US
Practice Address - Phone:281-561-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty