# SIMPLE DENTAL PLLC

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

## Provider details

- **NPI number:** 1144989484
- **Authorized official:** NICOLE GREEN (OFFICE MANAGER)
- **Authorized official phone:** (817) 928-5659

## Contact information

- **Practice address:** 1012 S CROWLEY RD STE C, CROWLEY, TX 76036-3664
- **Practice address phone:** (817) 928-5659
- **Practice address fax:** (817) 241-0485
- **Mailing address:** PO BOX 1216, ALVARADO, TX 76009-1216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/14/2021
- **Last updated:** 12/14/2021