Provider Demographics
NPI:1215414388
Name:TEXAS DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:TEXAS DENTAL PARTNERS PLLC
Other - Org Name:NIXON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-338-1468
Mailing Address - Street 1:200 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NIXON
Mailing Address - State:TX
Mailing Address - Zip Code:78140-2737
Mailing Address - Country:US
Mailing Address - Phone:830-582-2571
Mailing Address - Fax:830-582-3141
Practice Address - Street 1:200 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:TX
Practice Address - Zip Code:78140-2737
Practice Address - Country:US
Practice Address - Phone:830-582-2571
Practice Address - Fax:830-582-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty