1558784926 NPI number — DENTAL HEALTH PROGRAMS, INC.

Table of content: (NPI 1558784926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558784926 NPI number — DENTAL HEALTH PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL HEALTH PROGRAMS, INC.
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:
1558784926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36202-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-741-7340
Provider Business Mailing Address Fax Number:
256-741-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3910 GASTON AVE.
Provider Second Line Business Practice Location Address:
SUITE #175
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-257-1082
Provider Business Practice Location Address Fax Number:
214-823-2326
Provider Enumeration Date:
01/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CRUSE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
629-999-5006

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 329499301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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