MEDICARE: DENTAL HEALTH ASSOCIATES OF TX, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083305239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH ASSOCIATES OF TX, P.C.

Provider Business Mailing Address
First Line	:	220 S DENTON TAP RD STE 103
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S DENTON TAP RD STE 103
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5098
Country	:	US
Telephone Number	:	469-470-4951
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	COURTNEY R MONTEITH
Credential	:
Telephone Number	:	217-540-8306

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	05/18/2023

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