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
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/18/2013
Last updated
10/18/2013
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