1467677088 NPI number — HOME TOWN DENTAL OF SHERMAN PC

Table of content: (NPI 1467677088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467677088 NPI number — HOME TOWN DENTAL OF SHERMAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME TOWN DENTAL OF SHERMAN PC
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:
6
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:
1467677088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 TEXOMA PKWY STE 1018
Provider Second Line Business Mailing Address:
4800 N TEXOMA PKWY STE 1018
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-2092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-813-4867
Provider Business Mailing Address Fax Number:
903-686-2032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 TEXOMA PKWY STE 1018
Provider Second Line Business Practice Location Address:
4800 N TEXOMA PKWY STE 1018
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090-2092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-813-4867
Provider Business Practice Location Address Fax Number:
903-686-2032
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GURAM
Authorized Official First Name:
MONJIT
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
817-528-6665

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  15987 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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