Organization
SCOTT & WHITE CLINIC
Active
Other names
Scott & White Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALICE CANTU (ASSOCIATE VICE PRESIDENT, RCO)
(254) 215-9791
Entity
Organization
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
2401 S 31ST ST, TEMPLE, TX 76508-0001
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021CM
BLUE SHIELD
TX
05
—
1266694-05
—
TX
Enumeration date
04/25/2006
Last updated
04/23/2013
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