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Organization
MCCASLAND
Active
Organization
MCCASLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTI TIENDA (OFFICE MANAGER)
(806) 894-6830
Entity
Organization
Contact information
Practice address
124 CLUBVIEW DR, LEVELLAND, TX 79336-6304
(806) 894-6830
(806) 897-1720
Mailing address
124 CLUBVIEW DR, LEVELLAND, TX 79336-6304
(806) 894-6830
(806) 897-1720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18668
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316950256
—
TX
Enumeration date
03/16/2017
Last updated
03/16/2017
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