Provider Demographics
NPI:1750510020
Name:TEXOMA SIGNATURE DENTAL PC
Entity Type:Organization
Organization Name:TEXOMA SIGNATURE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-436-9376
Mailing Address - Street 1:2907 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3424
Mailing Address - Country:US
Mailing Address - Phone:903-893-1111
Mailing Address - Fax:903-893-1113
Practice Address - Street 1:2907 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3424
Practice Address - Country:US
Practice Address - Phone:903-893-1111
Practice Address - Fax:903-893-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty