Provider Demographics
NPI:1104057819
Name:HEIGHTS DENTAL CENTER
Entity type:Organization
Organization Name:HEIGHTS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-699-3359
Mailing Address - Street 1:PO BOX 2547
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-0547
Mailing Address - Country:US
Mailing Address - Phone:254-699-3359
Mailing Address - Fax:254-699-0597
Practice Address - Street 1:201 W FM 2410 RD
Practice Address - Street 2:SUITE D
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1709
Practice Address - Country:US
Practice Address - Phone:254-699-3359
Practice Address - Fax:254-699-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty