Provider Demographics
NPI:1104039957
Name:DENTAL HEALTH PROFESSIONALS
Entity type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:2440 N JOSEY LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1668
Mailing Address - Country:US
Mailing Address - Phone:972-323-0501
Mailing Address - Fax:972-323-0551
Practice Address - Street 1:2440 N JOSEY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1668
Practice Address - Country:US
Practice Address - Phone:972-323-0501
Practice Address - Fax:972-323-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty