# DENTAL PROVIDER RESOURCES 5, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waterway Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023350212
- **Authorized official:** DR. JARED BRUGGEMAN DDS (OWNER/DOCTOR)
- **Authorized official phone:** (817) 328-6153

## Contact information

- **Practice address:** 26219 INTERSTATE 45, THE WOODLANDS, TX 77380-1903
- **Practice address phone:** (817) 328-6150
- **Mailing address:** 1000 TEXAN TRL, STE 229, GRAPEVINE, TX 76051-3776
- **Mailing address phone:** (817) 328-6150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0001X | Public Health Dentistry | — | NULL | Yes |
| 1223D0001X | Public Health Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/26/2013
- **Last updated:** 04/01/2013