Provider Demographics
NPI:1275825531
Name:PIPE CREEK DENTAL CENTER INC.
Entity Type:Organization
Organization Name:PIPE CREEK DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER-SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:GUAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-535-6200
Mailing Address - Street 1:P.O. BOX 63372
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063
Mailing Address - Country:US
Mailing Address - Phone:830-535-6200
Mailing Address - Fax:
Practice Address - Street 1:9782 HWY. 16 SOUTH
Practice Address - Street 2:
Practice Address - City:PIPE CREEK
Practice Address - State:TX
Practice Address - Zip Code:78063
Practice Address - Country:US
Practice Address - Phone:830-535-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008.966-02Medicaid