Provider Demographics
NPI:1376631101
Name:DENTRUST DENTAL TEXAS, P.C.
Entity Type:Organization
Organization Name:DENTRUST DENTAL TEXAS, P.C.
Other - Org Name:DOCS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-362-5869
Mailing Address - Street 1:6097 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1810
Mailing Address - Country:US
Mailing Address - Phone:267-927-5000
Mailing Address - Fax:267-927-5007
Practice Address - Street 1:13405 IMMANUEL RD STE B
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8337
Practice Address - Country:US
Practice Address - Phone:267-927-5000
Practice Address - Fax:267-927-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty