1376631101 NPI number — DENTRUST DENTAL TEXAS, P.C.

Table of content: (NPI 1376631101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376631101 NPI number — DENTRUST DENTAL TEXAS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTRUST DENTAL TEXAS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOCS HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376631101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6097 EASTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIPERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18947-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-927-5000
Provider Business Mailing Address Fax Number:
267-927-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13405 IMMANUEL RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-8337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-927-5000
Provider Business Practice Location Address Fax Number:
267-927-5007
Provider Enumeration Date:
10/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DECARLO
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
267-362-5869

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)