Provider Demographics
NPI:1942338546
Name:DENTAL CARE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DENTAL CARE ASSOCIATES, P.C.
Other - Org Name:HARGROVE DENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTAL ASSISTANT ADMINSTRATIVE OFF
Authorized Official - Prefix:MS
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:BELLE
Authorized Official - Last Name:DENSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DENTAL ASSISTANT
Authorized Official - Phone:979-776-4364
Mailing Address - Street 1:1313 BRIARCREST DR STE D
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5232
Mailing Address - Country:US
Mailing Address - Phone:979-776-4364
Mailing Address - Fax:979-776-4360
Practice Address - Street 1:1313 BRIARCREST DR STE D
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5232
Practice Address - Country:US
Practice Address - Phone:979-776-4364
Practice Address - Fax:979-776-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16734122300000X
TX9539122300000X
TX167301223P0300X
TX46961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60428-01OtherCHIPS