Provider Demographics
NPI:1962264655
Name:PLAQUE PANTHER DENTISTRY, PLLC
Entity type:Organization
Organization Name:PLAQUE PANTHER DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:JARROD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-569-8067
Mailing Address - Street 1:18916 ELK HORN DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6083
Mailing Address - Country:US
Mailing Address - Phone:512-569-8067
Mailing Address - Fax:
Practice Address - Street 1:201 COUNTY ROAD 138 # 204
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5180
Practice Address - Country:US
Practice Address - Phone:512-569-8067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental