Provider Demographics
NPI:1508189879
Name:DENTISTRY OF TEXAS, PC
Entity Type:Organization
Organization Name:DENTISTRY OF TEXAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:O
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:770-916-5028
Mailing Address - Street 1:400 GALLERIA PKWY SE STE 800
Mailing Address - Street 2:ATTN; CHRIS WOODS
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6413
Mailing Address - Country:US
Mailing Address - Phone:770-916-5028
Mailing Address - Fax:678-247-7858
Practice Address - Street 1:1932 E SOUTHEAST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8337
Practice Address - Country:US
Practice Address - Phone:770-916-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty