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Organization
SOUTHEAST TEXAS DENTAL CENTER
Active
Organization
SOUTHEAST TEXAS DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE CAMILLE JORDAN (BUSINESS MANAGER)
(409) 384-5091
Entity
Organization
Contact information
Practice address
190 N ZAVALLA ST, JASPER, TX 75951-4119
(409) 384-5091
(409) 384-5046
Mailing address
190 N ZAVALLA ST, JASPER, TX 75951-4119
(409) 384-5091
(409) 384-5046
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
TX
Other
Enumeration date
07/18/2012
Last updated
07/18/2012
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