MEDICARE: DENTAL HEALTH ASSOCIATES OF TEXAS, PC.

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	:	1245520311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH ASSOCIATES OF TEXAS, PC.

Provider Business Mailing Address
First Line	:	1270 STATE HIGHWAY 173 N
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4738
Country	:	US
Telephone Number	:	830-663-4401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 STATE HIGHWAY 173 N
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4738
Country	:	US
Telephone Number	:	830-663-4401
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE/CREDENTIALING
Name	:	JENNIFER HOELSCHER
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	02/05/2014

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