Provider Demographics
NPI:1124771142
Name:DENTAL PROFESSIONALS OF TEXAS, P.A.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF TEXAS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8905
Mailing Address - Street 1:1615 FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2715
Mailing Address - Country:US
Mailing Address - Phone:254-778-6440
Mailing Address - Fax:
Practice Address - Street 1:1615 FOREST TRL
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2715
Practice Address - Country:US
Practice Address - Phone:254-778-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF TEXAS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty