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Provider Information for 1043642929

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1043642929

Calendar   Last Updated:  2021-07-28
  Certification Date:  2021-07-28


Name Value
NPI 1043642929
Enumeration Date 2013-08-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 345 W FM 544 STE 100B
MURPHY, TX 75094-4408
United States

Phone: 694-690-1699 | Fax: 469-969-0053
View Map External Link
Primary Practice Address 619 W FM 544 STE 1B
MURPHY, TX 75094-4587
United States

Phone: 469-969-0169 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice TX 32520
No 122300000X - Dentist NE 7109
No 122300000X - Dentist SD D1025
No 122300000X - Dentist TX 32520