Healthcare Provider Details

I. General information

NPI: 1376776807
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES OF TEXAS, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 W WHITE OAK TER STE A
CONROE TX
77304-3590
US

IV. Provider business mailing address

1805 W WHITE OAK TER STE A
CONROE TX
77304-3590
US

V. Phone/Fax

Practice location:
  • Phone: 936-588-4433
  • Fax:
Mailing address:
  • Phone: 936-588-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOELSCHER
Title or Position: INSURANCE/CREDENTAILING
Credential:
Phone: 217-540-5100