| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 200 E 2nd St, Nixon, Texas |
| Authorized Official Name and Position | Angela Mathew (OWNER) |
| Authorized Official Contact | 5124664468 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 E 2nd St Nixon TX 78140-2737 Ph: (830) 582-2571 | 200 E 2nd St Nixon TX 78140-2737 Ph: (830) 582-2571 |
| NPI Number | 1861860967 |
|---|---|
| Provider Enumeration Date | 09/04/2015 |
| Last Update Date | 09/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861860967 | NPI | - | NPPES |
| 2177610 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |