Organization
RESTORE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHESH B. GONDI DMD (PRESIDENT)
(903) 257-8815
Entity
Organization
Contact information
Practice address
3108 W STATE HIGHWAY 22, CORSICANA, TX 75110-2435
(903) 257-8815
(903) 900-4184
Mailing address
3108 W STATE HIGHWAY 22, CORSICANA, TX 75110-2435
(903) 257-8815
(903) 900-4184
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
22213
TX
261QD0000X
Dental Clinic/Center
Primary
22213
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306909080
NPI
TX
Enumeration date
01/12/2015
Last updated
01/14/2016
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