Healthcare Provider Details

I. General information

NPI: 1720664121
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES OF TEXAS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 ROUGHRIDER DR
WINDCREST TX
78239-2446
US

IV. Provider business mailing address

8211 ROUGHRIDER DR
WINDCREST TX
78239-2446
US

V. Phone/Fax

Practice location:
  • Phone: 210-657-0101
  • Fax:
Mailing address:
  • Phone:
  • 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: TABATHA LEMKE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-6078