Provider Demographics
NPI:1356168272
Name:C & C DENTAL FAMILY PLLC
Entity type:Organization
Organization Name:C & C DENTAL FAMILY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-581-5500
Mailing Address - Street 1:1310 W CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5483
Mailing Address - Country:US
Mailing Address - Phone:903-581-5500
Mailing Address - Fax:903-581-5510
Practice Address - Street 1:1310 W CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5483
Practice Address - Country:US
Practice Address - Phone:903-581-5500
Practice Address - Fax:903-581-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty