1497035703 NPI number — GOFORTH DENTAL PARTNERSHIP LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497035703 NPI number — GOFORTH DENTAL PARTNERSHIP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOFORTH DENTAL PARTNERSHIP LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497035703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1912 S 5TH ST
Provider Second Line Business Mailing Address:
#448
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76706-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-378-1883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 ELMHURST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
KYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-793-9683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ALAMO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
IGNACIO
Authorized Official Title or Position:
DENTIST PARTNER
Authorized Official Telephone Number:
210-378-1883

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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