Provider Demographics
NPI:1700052065
Name:DENTAL HEALTH FOR ARLINGTON, INC.
Entity Type:Organization
Organization Name:DENTAL HEALTH FOR ARLINGTON, INC.
Other - Org Name:DENTAL HEALTH ARLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-277-1165
Mailing Address - Street 1:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76004-1542
Mailing Address - Country:US
Mailing Address - Phone:817-277-1165
Mailing Address - Fax:817-277-1106
Practice Address - Street 1:201 N EAST ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-7517
Practice Address - Country:US
Practice Address - Phone:817-277-1165
Practice Address - Fax:817-277-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009828701Medicaid