Provider Demographics
NPI:1417594557
Name:ACRE WOOD DENTAL - TEMPLE PA
Entity Type:Organization
Organization Name:ACRE WOOD DENTAL - TEMPLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-778-4951
Mailing Address - Street 1:5519 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7422
Mailing Address - Country:US
Mailing Address - Phone:254-778-4951
Mailing Address - Fax:254-778-4199
Practice Address - Street 1:5519 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7422
Practice Address - Country:US
Practice Address - Phone:254-778-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty