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	:	1619387586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH ASSOCIATES OF TEXAS, PC

Provider Business Mailing Address
First Line	:	3001 DALLAS PKWY
Second Line	:	SUITE A
City	:	PLANO
State	:	TX
Zip	:	75093-5900
Country	:	US
Telephone Number	:	972-964-5686
Fax Number	:	972-964-9645

Provider Business Practice Location Address
First Line	:	3001 DALLAS PKWY
Second Line	:	SUITE A
City	:	PLANO
State	:	TX
Zip	:	75093-5900
Country	:	US
Telephone Number	:	972-964-5686
Fax Number	:	972-964-9645

Authorized Official
Title or Position	:	CRED. SUPERVISOR
Name	:	KIM WILSON
Credential	:
Telephone Number	:	217-540-5170

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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