Provider Demographics
NPI:1417729245
Name:ETX DENTAL PLLC
Entity Type:Organization
Organization Name:ETX DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-796-9051
Mailing Address - Street 1:1 BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3402
Mailing Address - Country:US
Mailing Address - Phone:903-796-9051
Mailing Address - Fax:
Practice Address - Street 1:601 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-1851
Practice Address - Country:US
Practice Address - Phone:903-665-3914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental