| Distefano Dental Studio | |
|
3535 N Fourth St Ste 303 Longview TX 75605-0038 | |
| (903) 759-4607 | |
| Not Available |
| Full Name | Distefano Dental Studio |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3535 N Fourth St Ste 303, Longview, Texas |
| Authorized Official Name and Position | Jenny Garcia-rocha (SR CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Distefano Dental Studio 3535 N Fourth St Ste 303 Longview TX 75605-0038 Ph: (903) 759-4607 | Distefano Dental Studio 3535 N Fourth St Ste 303 Longview TX 75605-0038 Ph: (903) 759-4607 |
| NPI Number | 1114803483 |
|---|---|
| Provider Enumeration Date | 08/13/2025 |
| Last Update Date | 08/13/2025 |
| Certification Date | 08/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114803483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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