Healthcare Provider Details

I. General information

NPI: 1598986408
Provider Name (Legal Business Name): TEXAS DENTAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 S PADRE ISLAND DR
CORPUS CHRISTI TX
78411-4203
US

IV. Provider business mailing address

2536 AMHERST ST STE. A
HOUSTON TX
77005-3207
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-1117
  • Fax: 361-986-1118
Mailing address:
  • Phone: 713-490-8880
  • Fax: 713-490-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10849
License Number StateTX

VIII. Authorized Official

Name: DR. KENT E. ZIEGENBEIN
Title or Position: OWNER/GENERAL DENTIST
Credential: DDS
Phone: 713-490-8880