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General NPI Number Information
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NPI Number | 1407277239
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Entity Type | Organization
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Legal Business Name | NORTHEAST TEXAS COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 2886 FM 1735, CHAPEL HILL ROAD
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City | MT. PLEASANT
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State | TX
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Zip | 75455
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Country | US
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Telephone | 903-434-8350
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Fax | 903-434-4424
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Provider Business Mailing Address
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Address Line | PO BOX 1307
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City | MT PLEASANT
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State | TX
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Zip | 75456-9991
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Country | US
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Telephone | 903-434-8350
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Fax | 903-434-4424
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DEBORAH JO JOHNSON
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Credential | RDH, PH.D
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Telephone | 903-434-8352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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