Provider Demographics
NPI:1962619262
Name:NGM DENTAL GROUP, PLLC
Entity type:Organization
Organization Name:NGM DENTAL GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-264-5795
Mailing Address - Street 1:2126 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3764
Mailing Address - Country:US
Mailing Address - Phone:972-264-5795
Mailing Address - Fax:972-264-9874
Practice Address - Street 1:2126 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3764
Practice Address - Country:US
Practice Address - Phone:972-264-5795
Practice Address - Fax:972-264-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty