1265388862 NPI number — PEDIATRIC DENTISTRY OF MARSHALL LLP

Table of content: TIFFANY JAHN (NPI 1851257257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265388862 NPI number — PEDIATRIC DENTISTRY OF MARSHALL LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC DENTISTRY OF MARSHALL LLP
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:
Provider Other Organization Name Type Code:
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:
1265388862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3116 H G MOSLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-2941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-544-6060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S WASHINGTON AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75670-6845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-503-7757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2026

Additional Information

Authorized Official

Authorized Official Last Name:
HORNE
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
903-544-6060

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com