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Organization
TEXAS DENTAL IMPLANT CENTER
Active
Organization
TEXAS DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSE LYNN DEITZ RN, MBA (PRACTICE DIRECTOR)
(254) 300-8804
Entity
Organization
Contact information
Practice address
1237 COUNTY ROAD 197, JONESBORO, TX 76538-1207
(910) 922-9644
Mailing address
1237 COUNTY ROAD 197, JONESBORO, TX 76538-1207
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/18/2013
Last updated
10/18/2013
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