# CUSTOM DENTAL OF CARROLLTON, PLLC

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

## Provider details

- **NPI number:** 1366924383
- **Authorized official:** RENE RODGERS (COO)
- **Authorized official phone:** (405) 227-6100

## Contact information

- **Practice address:** 17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
- **Practice address phone:** (405) 227-6100
- **Mailing address:** 17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
- **Mailing address phone:** (405) 227-6100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 26171 | TX | Yes |

## Other

- **Enumeration date:** 09/06/2018
- **Last updated:** 09/08/2021