Provider Demographics
NPI:1598050841
Name:ENT ASSOCIATES OF CENTRAL TEXAS
Entity Type:Organization
Organization Name:ENT ASSOCIATES OF CENTRAL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-402-9222
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75168-0798
Mailing Address - Country:US
Mailing Address - Phone:972-937-7240
Mailing Address - Fax:
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:318-402-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9533207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty