Provider Demographics
NPI:1316410186
Name:CASA DENTAL-DUMAS PLLC
Entity Type:Organization
Organization Name:CASA DENTAL-DUMAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-809-4865
Mailing Address - Street 1:1261 W GREEN OAKS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-8349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 S DUMAS AVE STE 112
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-6112
Practice Address - Country:US
Practice Address - Phone:806-934-3170
Practice Address - Fax:806-934-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty