NPI age
19 years
Enumerated 2007-04-24
Across 15661 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 836104 | TRICARE UNITED CONCORDIA |
| 01 (TX) | 14594 | STATE LICENSE # |
| 01 (TX) | 74-2889807 | TAX ID# |
| 01 (TX) | D14594 | BLUE CROSS BLUE SHIELD |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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