MEDICARE: EAGLE DENTAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22575	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B22575-01	OTHER	CHIP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	B22575-02	OTHER	CHIP

General Provider Information

NPI Number	:	1073832291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE DENTAL P.C.

Provider Business Mailing Address
First Line	:	12609 S. GESSNER DRIVE
Second Line	:	STE. F
City	:	HOUSTON
State	:	TX
Zip	:	77071-2803
Country	:	US
Telephone Number	:	713-774-6700
Fax Number	:	713-774-6704

Provider Business Practice Location Address
First Line	:	12609 S GESSNER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2803
Country	:	US
Telephone Number	:	713-774-6700
Fax Number	:	713-774-6704

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVIN E ODIA
Credential	:	DDS
Telephone Number	:	832-790-2223

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	06/23/2011

Similar Medicare Providers

1538489356 — JOYCE EGBE, MD. PA.
Practice Location Address:

12609 S GESSNER DR , SUITE G
HOUSTON, TX
77071-2803

Practice Phone: 713-773-2700
Practice Fax: 713-773-2707

1588528178 — DINA URENA MA, LPC
Practice Location Address:

14715 GLADEBROOK DR
HOUSTON, TX
77068-2803

Practice Phone: 832-819-0554
Practice Fax:

1851343420 — VERICARE OF TEXAS, P.A.
Practice Location Address:

303 HOLLOW TREE LN
HOUSTON, TX
77090-2803

Practice Phone: 800-257-8715
Practice Fax: 800-819-1655

1831225002 — SPRING BRANCH ISD
Practice Location Address:

955 CAMPBELL RD
HOUSTON, TX
77024-2803

Practice Phone: 713-464-1511
Practice Fax:

1073634762 — EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
Practice Location Address:

2803 QUINCANNON LN
HOUSTON, TX
77043-1603

Practice Phone: 713-690-3127
Practice Fax:

1821252909 — SOUTHSIDE MEDICAL TRANSPORATION
Practice Location Address:

6829 ALMEDA GENOA RD
HOUSTON, TX
77075-2803

Practice Phone: 713-991-5518
Practice Fax: 713-991-5357

Directions to “EAGLE DENTAL P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.