# RESTORE DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104215367
- **Authorized official:** DR. MAHESH B. GONDI DMD (PRESIDENT)
- **Authorized official phone:** (903) 257-8815

## Contact information

- **Practice address:** 3108 W STATE HIGHWAY 22, CORSICANA, TX 75110-2435
- **Practice address phone:** (903) 257-8815
- **Practice address fax:** (903) 900-4184
- **Mailing address:** 3108 W STATE HIGHWAY 22, CORSICANA, TX 75110-2435
- **Mailing address phone:** (903) 257-8815
- **Mailing address fax:** (903) 900-4184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22213 | TX | — |
| 261QD0000X | Dental Clinic/Center | 22213 | TX | Yes |

## Other

- **Enumeration date:** 01/12/2015
- **Last updated:** 01/14/2016