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General NPI Number Information
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NPI Number | 1861236135
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES OF TEXAS, PC
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 11104 SLIDE RD
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City | LUBBOCK
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State | TX
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Zip | 79424-2439
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Country | US
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Telephone | 806-705-7102
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Fax | 806-705-7156
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Provider Business Mailing Address
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Address Line | 11104 SLIDE RD
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City | LUBBOCK
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State | TX
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Zip | 79424-2439
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Country | US
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Telephone | 806-705-7102
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Fax | 806-705-7156
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CEMYIRA MCDOUGAL
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Credential |
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Telephone | 217-764-8609
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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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