# AGGIELAND DENTAL ASSOCIATES, PC

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

## Provider details

- **NPI number:** 1407078892
- **Authorized official:** DR. ROXANE G MLCAK-SPENCE (VP)
- **Authorized official phone:** (979) 696-4511

## Contact information

- **Practice address:** 2700 EARL RUDDER FRWY S, SUITE 1900, COLLEGE STATION, TX 77845-5032
- **Practice address phone:** (979) 696-4511
- **Mailing address:** 2700 EARL RUDDER FRWY S, SUITE 1900, COLLEGE STATION, TX 77845-5032
- **Mailing address phone:** (979) 696-4511

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 15745 | TX | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 82D692 | BCBS PROVIDER \# | TX |