Provider Demographics
NPI:1053595868
Name:DENTAL & SPECIALTY IMAGING
Entity type:Organization
Organization Name:DENTAL & SPECIALTY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-347-8165
Mailing Address - Street 1:3199 DOWLEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7284
Mailing Address - Country:US
Mailing Address - Phone:409-347-8165
Mailing Address - Fax:409-347-8162
Practice Address - Street 1:3199 DOWLEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7284
Practice Address - Country:US
Practice Address - Phone:409-347-8165
Practice Address - Fax:409-347-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology