Provider Demographics
NPI:1366088130
Name:TERRY COUNTY DENTAL, LLC
Entity type:Organization
Organization Name:TERRY COUNTY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-342-5085
Mailing Address - Street 1:1307 TAHOKA RD
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-4006
Mailing Address - Country:US
Mailing Address - Phone:807-637-8386
Mailing Address - Fax:
Practice Address - Street 1:1307 TAHOKA RD
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-4006
Practice Address - Country:US
Practice Address - Phone:807-637-8386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty