Provider Demographics
NPI:1619963485
Name:DENTAL HEALTH PROGRAMS, INC.
Entity Type:Organization
Organization Name:DENTAL HEALTH PROGRAMS, INC.
Other - Org Name:COMMUNITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-590-2969
Mailing Address - Street 1:PO BOX 532489
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053
Mailing Address - Country:US
Mailing Address - Phone:214-590-2969
Mailing Address - Fax:214-266-1001
Practice Address - Street 1:801 CONOVER DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1519
Practice Address - Country:US
Practice Address - Phone:214-590-2969
Practice Address - Fax:214-266-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091293301Medicaid