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Organization
SDS-BILL OWENS PKWY PLLC
Active
Organization
SDS-BILL OWENS PKWY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL CHRISTOPHER MACK DDS (MANAGER)
(903) 236-4050
Entity
Organization
Contact information
Practice address
2840 BILL OWENS PKWY STE B, LONGVIEW, TX 75605-2150
(903) 759-2261
Mailing address
2840 BILL OWENS PKWY STE B, LONGVIEW, TX 75605-2150
(903) 759-2261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13770
TX
1223G0001X
General Practice Dentistry
32168
TX
Other
Enumeration date
12/01/2017
Last updated
12/01/2017
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