Healthcare Provider Details

I. General information

NPI: 1316499296
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES OF TEXAS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8678 LOUETTA RD STE A
SPRING TX
77379-6680
US

IV. Provider business mailing address

8678 LOUETTA RD STE A
SPRING TX
77379-6680
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-3959
  • Fax:
Mailing address:
  • Phone: 281-376-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA TEUTSCH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8972