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General NPI Number Information
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NPI Number | 1215391057
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Entity Type | Organization
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Legal Business Name | CEN-TEX FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 3000 OLD FM 440 RD STE 106
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City | KILLEEN
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State | TX
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Zip | 76549-1603
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Country | US
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Telephone | 254-300-7649
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11832
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City | KILLEEN
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State | TX
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Zip | 76547-1832
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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 | MGR
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Name | SUZANNE BALDWIN
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Credential |
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Telephone | 254-300-7649
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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 | 25314
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License Number State | TX
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