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

Table of Contents

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)