Provider Demographics
NPI:1912918798
Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Entity Type:Organization
Organization Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Other - Org Name:TEXAS A&M SCHOOL OF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-436-0398
Mailing Address - Street 1:3000 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226
Mailing Address - Country:US
Mailing Address - Phone:214-828-8100
Mailing Address - Fax:214-874-4552
Practice Address - Street 1:3000 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226
Practice Address - Country:US
Practice Address - Phone:214-828-8100
Practice Address - Fax:214-874-4552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21845122300000X
122300000X, 1223S0112X
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty