Healthcare Provider Details

I. General information

NPI: 1174053680
Provider Name (Legal Business Name): VAN ALSTYNE FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E JEFFERSON ST
VAN ALSTYNE TX
75495-3420
US

IV. Provider business mailing address

217 E JEFFERSON ST
VAN ALSTYNE TX
75495-3420
US

V. Phone/Fax

Practice location:
  • Phone: 903-482-6339
  • Fax: 903-385-7255
Mailing address:
  • Phone: 903-482-6339
  • Fax: 903-385-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number38855
License Number StateTX

VIII. Authorized Official

Name: MRS. BRENDA BROCK
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 903-268-6542