Provider Demographics
NPI:1972266005
Name:FAMILY DENTAL CARE-LUMBERTON PLLC
Entity type:Organization
Organization Name:FAMILY DENTAL CARE-LUMBERTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:148 COUNTRY LANE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-6802
Mailing Address - Country:US
Mailing Address - Phone:409-755-3933
Mailing Address - Fax:409-227-0678
Practice Address - Street 1:148 COUNTRY LANE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-6802
Practice Address - Country:US
Practice Address - Phone:409-755-3933
Practice Address - Fax:409-227-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty