Provider Demographics
NPI:1316604382
Name:DNTL TEXAS
Entity type:Organization
Organization Name:DNTL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOSS LADY
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-703-9468
Mailing Address - Street 1:2750 W MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1830
Mailing Address - Country:US
Mailing Address - Phone:281-554-9090
Mailing Address - Fax:
Practice Address - Street 1:501 S FRIENDSWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4508
Practice Address - Country:US
Practice Address - Phone:281-554-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental