Provider Demographics
NPI:1083298434
Name:DENTAL HEALTH ASSOCIATES OF TX, PC
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF TX, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:2430 RAYFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1936
Mailing Address - Country:US
Mailing Address - Phone:346-298-6445
Mailing Address - Fax:
Practice Address - Street 1:2430 RAYFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1936
Practice Address - Country:US
Practice Address - Phone:346-298-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH ASSOCIATES OF TX, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty