Provider Demographics
NPI:1437289733
Name:DENTAL SPECIALTY OF SAGINAW
Entity Type:Organization
Organization Name:DENTAL SPECIALTY OF SAGINAW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE REP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-367-6453
Mailing Address - Street 1:701 W BAILEY BOSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1007
Mailing Address - Country:US
Mailing Address - Phone:817-367-6453
Mailing Address - Fax:
Practice Address - Street 1:701 W BAILEY BOSWELL RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1007
Practice Address - Country:US
Practice Address - Phone:817-367-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209051223E0200X
TX165351223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty