| Nacogdoches Pediatric Dentistry | |
|
1602 E Starr Ave Suite 203 Nacogdoches TX 75961-4312 | |
| (936) 559-7200 | |
| Not Available |
| Full Name | Nacogdoches Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1602 E Starr Ave, Nacogdoches, Texas |
| Authorized Official Name and Position | Jennfier Criss (PRESIDENT) |
| Authorized Official Contact | 9365597200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nacogdoches Pediatric Dentistry 1602 E Starr Ave Suite 203 Nacogdoches TX 75961-4312 Ph: (936) 559-7200 | Nacogdoches Pediatric Dentistry 1602 E Starr Ave Suite 203 Nacogdoches TX 75961-4312 Ph: (936) 559-7200 |
| NPI Number | 1407234248 |
|---|---|
| Provider Enumeration Date | 05/13/2015 |
| Last Update Date | 05/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407234248 | NPI | - | NPPES |
| 16283102 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 21417 (Texas) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 21417 (Texas) | Primary |
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