| Dental Clinic | |
|
117 Southpoint Loop Suite 400 Livingston TX 77351-8899 | |
| (936) 327-9490 | |
| (936) 327-9496 |
| Full Name | Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 117 Southpoint Loop, Livingston, Texas |
| Authorized Official Name and Position | Tracy Vaughn (OFFICE MANAGER) |
| Authorized Official Contact | 9363279490 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Clinic 117 Southpoint Loop Ste 400 Livingston TX 77351-8899 Ph: (936) 327-9490 | Dental Clinic 117 Southpoint Loop Suite 400 Livingston TX 77351-8899 Ph: (936) 327-9490 |
| NPI Number | 1235412743 |
|---|---|
| Provider Enumeration Date | 09/21/2011 |
| Last Update Date | 01/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235412743 | NPI | - | NPPES |
| 120788803 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18352 (Texas) | Primary |
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