Provider Demographics
NPI:1801256797
Name:WAXAHACHIE FAMILY DENTISTRY, LLP
Entity type:Organization
Organization Name:WAXAHACHIE FAMILY DENTISTRY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-937-4370
Mailing Address - Street 1:125 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-9106
Mailing Address - Country:US
Mailing Address - Phone:972-937-4370
Mailing Address - Fax:972-937-4369
Practice Address - Street 1:125 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-9106
Practice Address - Country:US
Practice Address - Phone:972-937-4370
Practice Address - Fax:972-937-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191511223G0001X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477767903OtherPERSONAL NPI