Provider Demographics
NPI:1255192902
Name:RED BUTTE DENTAL LLC
Entity type:Organization
Organization Name:RED BUTTE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-699-3225
Mailing Address - Street 1:581 PAN AMERICAN DR STE 6
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1960
Mailing Address - Country:US
Mailing Address - Phone:254-699-3225
Mailing Address - Fax:254-699-4647
Practice Address - Street 1:581 PAN AMERICAN DR STE 6
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1960
Practice Address - Country:US
Practice Address - Phone:254-699-3225
Practice Address - Fax:254-699-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619546173OtherDENTAL