Provider Demographics
NPI:1740750801
Name:DENTON FAMILY CLINIC CORP
Entity Type:Organization
Organization Name:DENTON FAMILY CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HATSHEPSUT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-242-3404
Mailing Address - Street 1:2412 OLD NORTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1524
Mailing Address - Country:US
Mailing Address - Phone:469-283-8708
Mailing Address - Fax:
Practice Address - Street 1:2412 OLD NORTH RD STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1524
Practice Address - Country:US
Practice Address - Phone:469-283-8708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty