Organization
CUSTOM DENTAL OF THE COLONY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE RODGERS (COO)
(405) 227-6100
Entity
Organization
Contact information
Practice address
4695 N COLONY BLVD STE 104, THE COLONY, TX 75056-3330
(972) 625-0213
Mailing address
4695 N COLONY BLVD STE 104, THE COLONY, TX 75056-3330
(972) 625-0213
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/09/2022
Last updated
01/09/2022
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