Provider Demographics
NPI:1366873929
Name:ELDER DENT OF TEXAS, PLLC
Entity type:Organization
Organization Name:ELDER DENT OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-498-0093
Mailing Address - Street 1:20079 STONE OAK PKWY STE 1105-436
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6942
Mailing Address - Country:US
Mailing Address - Phone:210-888-0119
Mailing Address - Fax:210-881-6823
Practice Address - Street 1:20079 STONE OAK PKWY STE 1105-436
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6942
Practice Address - Country:US
Practice Address - Phone:502-498-0093
Practice Address - Fax:210-881-6823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty