| None | |
|
3164 Junction Hwy Ste W-1 Ingram TX 78025-3194 | |
| (830) 367-1171 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3164 Junction Hwy Ste W-1, Ingram, Texas |
| Authorized Official Name and Position | Susannah M C Mitchell (OWNER) |
| Authorized Official Contact | 3036711718 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 3164 Junction Hwy Ste W-1 Ingram TX 78025-3194 Ph: (830) 367-1171 | None 3164 Junction Hwy Ste W-1 Ingram TX 78025-3194 Ph: (830) 367-1171 |
| NPI Number | 1952016503 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 05/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952016503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |