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General NPI Number Information
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NPI Number | 1003136714
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Entity Type | Organization
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Legal Business Name | TEXARKANA DENTAL SPECIALISTS
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 2800 TEXAS BLVD
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City | TEXARKANA
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State | TX
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Zip | 75503-4109
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Country | US
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Telephone | 903-792-3636
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Fax | 903-792-0062
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Provider Business Mailing Address
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Address Line | 2800 TEXAS BLVD
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City | TEXARKANA
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State | TX
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Zip | 75503-4109
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Country | US
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Telephone | 903-792-3636
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Fax | 903-792-0062
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. SANDRA L SHAMBARGER
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Credential | DDS, MS
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Telephone | 903-792-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22320
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22346
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License Number State | TX
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