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General NPI Number Information
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NPI Number | 1912293853
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Entity Type | Organization
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Legal Business Name | NORTHEAST TEXAS PERIODONTAL SERVICES
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 3420 CLARKSVILLE ST
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City | PARIS
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State | TX
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Zip | 75460-8014
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Country | US
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Telephone | 903-785-4832
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6578
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City | PARIS
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State | TX
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Zip | 75461-6578
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Country | US
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Telephone | 903-785-4832
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN E HODGES
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Credential | D.D.S., M.S.
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Telephone | 903-785-4832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20061
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License Number State | TX
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