Provider Demographics
NPI:1376966747
Name:DENTAL HEALTH PROGRAMS, INC.
Entity Type:Organization
Organization Name:DENTAL HEALTH PROGRAMS, INC.
Other - Org Name:COMMUNITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-999-5006
Mailing Address - Street 1:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1168
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:256-741-7373
Practice Address - Street 1:13551 DENNIS LN
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4739
Practice Address - Country:US
Practice Address - Phone:972-241-2259
Practice Address - Fax:972-620-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329148601Medicaid