Provider Demographics
NPI:1588277214
Name:DENTAL HEALTH ASSOCIATES OF TEXAS, PC
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF TEXAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6078
Mailing Address - Street 1:1232 N LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1033
Mailing Address - Country:US
Mailing Address - Phone:936-756-3611
Mailing Address - Fax:
Practice Address - Street 1:1232 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1033
Practice Address - Country:US
Practice Address - Phone:936-756-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH ASSOCIATES OF TEXAS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty