Provider Demographics
NPI:1811670516
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:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:16530 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1006
Mailing Address - Country:US
Mailing Address - Phone:210-664-0462
Mailing Address - Fax:210-664-0063
Practice Address - Street 1:16530 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1006
Practice Address - Country:US
Practice Address - Phone:210-664-0462
Practice Address - Fax:210-664-0063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF TEXAS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-09
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty