Sds-Bill Owens Pkwy Pllc

NPI #1801301643 in Longview, Texas

Provider Information

NPI Number: 1801301643
Entity Type: Organization
Organization Name: Sds-Bill Owens Pkwy Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 1, 2017
Last Updated: Dec 1, 2017

Practice Location

Address: 2840 BILL OWENS PKWY STE B
City: Longview
State: Texas
ZIP Code: 75605-2150
Phone: (903) 759-2261

Authorized Official

Name: DR. SAMUEL CHRISTOPHER MACK, DDS
Title: MANAGER
Phone: (903) 236-4050

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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