# FAMILY DENTAL GROUP OF GREENVILLE PLLC

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

## Provider details

- **NPI number:** 1881135044
- **Authorized official:** DR. GARY RANDALL EVANS DDS (MEMBER)
- **Authorized official phone:** (903) 454-0918

## Contact information

- **Practice address:** 4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
- **Practice address phone:** (903) 454-0918
- **Practice address fax:** (903) 454-0311
- **Mailing address:** 4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
- **Mailing address phone:** (903) 454-0918
- **Mailing address fax:** (903) 454-0311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 11800 | TX | Yes |

## Other

- **Enumeration date:** 03/20/2017
- **Last updated:** 03/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1223G0001X | — | TX |