# CUSTOM DENTAL OF BONHAM PLLC

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

## Provider details

- **NPI number:** 1437795093
- **Authorized official:** BRYCE GATES DDS (DENTIST)
- **Authorized official phone:** (405) 227-6100

## Contact information

- **Practice address:** 2016 STATE HIGHWAY 121 N, BONHAM, TX 75418
- **Practice address phone:** (903) 227-6576
- **Mailing address:** 2016 N STATE HIGHWAY 121, BONHAM, TX 75418-2339
- **Mailing address phone:** (214) 616-1574

## Taxonomy

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

## Other

- **Enumeration date:** 11/19/2019
- **Last updated:** 09/08/2021