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Organization
RIO GRANDE CITY DENTAL PLLC
Active
Organization
RIO GRANDE CITY DENTAL PLLC
Active
Other names
Rodeo Dental and Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM HAILEY DUNKLIN DDS (OWNER)
(817) 529-8151
Entity
Organization
Contact information
Practice address
4024 E. US HIGHWAY 83, SUITE 100, RIO GRANDE CITY, TX 78582
(817) 529-8151
(817) 928-1681
Mailing address
100 E. 15TH ST., SUITE 520, FORT WORTH, TX 76102-6566
(817) 529-8151
(817) 925-1681
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168217112
—
TX
05
—
168217113
—
TX
05
—
168217114
—
TX
05
—
168217115
—
TX
05
—
168217116
—
TX
05
—
168217117
—
TX
05
—
168217118
—
TX
Enumeration date
05/16/2013
Last updated
10/26/2022
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