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General NPI Number Information
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NPI Number | 1265828941
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Entity Type | Organization
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Legal Business Name | CENTEX SMILE DOC PC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 2113 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-1849
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Country | US
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Telephone | 254-526-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 6420 S GENERAL BRUCE DR
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City | TEMPLE
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State | TX
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Zip | 76502-5830
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Country | US
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Telephone | 254-526-8666
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | SCOTT MURPHY
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Credential |
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Telephone | 254-781-4096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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