Provider Demographics
NPI:1669666798
Name:DENTAL HEALTH ASSOCIATES OF TX, P.C.
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF TX, P.C.
Other - Org Name:ABILENE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5309 BUFFALO GAP RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-4129
Mailing Address - Country:US
Mailing Address - Phone:325-692-3344
Mailing Address - Fax:325-692-3346
Practice Address - Street 1:5309 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-4129
Practice Address - Country:US
Practice Address - Phone:325-692-3344
Practice Address - Fax:325-692-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140961223G0001X
TX140861223G0001X
TX214601223G0001X
TX228911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty