Provider Demographics
NPI:1396286837
Name:MCCASLAND
Entity type:Organization
Organization Name:MCCASLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-894-6830
Mailing Address - Street 1:124 CLUBVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6304
Mailing Address - Country:US
Mailing Address - Phone:806-894-6830
Mailing Address - Fax:806-897-1720
Practice Address - Street 1:124 CLUBVIEW DR
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6304
Practice Address - Country:US
Practice Address - Phone:806-894-6830
Practice Address - Fax:806-897-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316950256Medicaid