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General NPI Number Information
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NPI Number | 1093439291
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Entity Type | Organization
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Legal Business Name | TH DENTAL PLLC
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 2511 N MAIN ST STE 101
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City | BELTON
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State | TX
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Zip | 76513-1554
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Country | US
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Telephone | 551-208-7289
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Fax |
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Provider Business Mailing Address
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Address Line | 2511 N MAIN ST STE 101
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City | BELTON
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State | TX
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Zip | 76513-1554
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Country | US
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Telephone | 940-399-7106
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CINTHIA FERNANDEZ
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Credential |
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Telephone | 940-399-7106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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