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General NPI Number Information
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NPI Number | 1053777490
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES OF TEXAS, PC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 12567 BROADWAY ST. SUITE 129
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City | PEARLAND
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State | TX
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Zip | 77584
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Country | US
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Telephone | 832-672-8648
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Fax | 832-672-6869
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Provider Business Mailing Address
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Address Line | 12567 BROADWAY ST. SUITE 129
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City | PEARLAND
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State | TX
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Zip | 77584
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING TEAM LEAD
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Name | KENDRA WALKER
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Credential |
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Telephone | 217-540-8312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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