Provider Demographics
NPI:1295011765
Name:DENTAL HEALTH ASSOCIATES OF TEXAS, PC.
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF TEXAS, PC.
Other - Org Name:PALM VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:505 E PALM VALLEY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3042
Mailing Address - Country:US
Mailing Address - Phone:512-255-6197
Mailing Address - Fax:512-964-4280
Practice Address - Street 1:505 E PALM VALLEY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3042
Practice Address - Country:US
Practice Address - Phone:512-255-6197
Practice Address - Fax:512-964-4280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH ASSOCIATES OF TEXAS, PC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty