Provider Demographics
NPI:1477894871
Name:FAMILY & SEDATION DENTISTRY OF TEXARKANA
Entity Type:Organization
Organization Name:FAMILY & SEDATION DENTISTRY OF TEXARKANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DARREL
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-832-1727
Mailing Address - Street 1:3201 RICHMOND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0708
Mailing Address - Country:US
Mailing Address - Phone:903-832-1727
Mailing Address - Fax:903-832-0797
Practice Address - Street 1:3201 RICHMOND RD STE 1
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0708
Practice Address - Country:US
Practice Address - Phone:903-832-1727
Practice Address - Fax:903-832-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27619261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental