Healthcare Provider Details

I. General information

NPI: 1114822202
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES OF TEXAS, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14917 SENDERA RANCH BLVD STE 133
HASLET TX
76052-4545
US

IV. Provider business mailing address

14917 SENDERA RANCH BLVD STE 133
HASLET TX
76052-4545
US

V. Phone/Fax

Practice location:
  • Phone: 682-474-2125
  • Fax: 682-474-2130
Mailing address:
  • Phone: 682-474-2125
  • Fax: 682-474-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CEMYIRA MCDOUGAL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-764-8609