=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235593575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL HEALTH ASSOCIATES OF TEXAS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2016
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3135 RILEY FUZZEL RD
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-363-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25412 INTERSTATE 45 N
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-1351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE/CREDENTIALING
-----------------------------------------------------
Name | HEATHER PRUEMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-540-8434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------