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Organization
PURELY DENTAL GROUP PLLC S-CORP
Active
Organization
PURELY DENTAL GROUP PLLC S-CORP
Active
Other names
Fate Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDY DAVONG D.D.S. (PRESIDENT)
(972) 804-5624
Entity
Organization
Contact information
Practice address
7406 STATE HIGHWAY 66, ROYSE CITY, TX 75189
(972) 460-4422
Mailing address
7406 STATE HIGHWAY 66, ROYSE CITY, TX 75189
(972) 460-4422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25750
TX
Other
Enumeration date
10/05/2013
Last updated
10/05/2013
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