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General NPI Number Information
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NPI Number | 1912918798
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Entity Type | Organization
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Legal Business Name | TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3000 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75226
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Country | US
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Telephone | 214-828-8100
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Fax | 214-874-4552
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Provider Business Mailing Address
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Address Line | 3000 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75226
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Country | US
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Telephone | 214-828-8100
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Fax | 214-874-4552
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH E. THOMAS
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Credential |
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Telephone | 214-828-8234
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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 | 21845
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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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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