Organization
CUSTOM DENTAL OF CARROLLTON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE RODGERS (COO)
(405) 227-6100
Entity
Organization
Contact information
Practice address
17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
(405) 227-6100
Mailing address
17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
(405) 227-6100
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
26171
TX
Other
Enumeration date
09/06/2018
Last updated
09/08/2021
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