Provider Demographics
NPI:1295337228
Name:SILVERTOOTH DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:SILVERTOOTH DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERTOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-445-4087
Mailing Address - Street 1:5140 FM 1252 W
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-1961
Mailing Address - Country:US
Mailing Address - Phone:903-445-4087
Mailing Address - Fax:
Practice Address - Street 1:2800 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1824
Practice Address - Country:US
Practice Address - Phone:903-297-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental