Provider Demographics
NPI:1073095980
Name:DECATUR ADVANCED DENTAL
Entity Type:Organization
Organization Name:DECATUR ADVANCED DENTAL
Other - Org Name:SMART MOUTH FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-3730
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1383
Mailing Address - Country:US
Mailing Address - Phone:940-627-3730
Mailing Address - Fax:512-582-8612
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1383
Practice Address - Country:US
Practice Address - Phone:940-627-3730
Practice Address - Fax:512-582-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty