Healthcare Provider Details

I. General information

NPI: 1912546672
Provider Name (Legal Business Name): ESCOBAR PREMIER DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 TELGE RD STE #100
CYPRESS TX
77429-2289
US

IV. Provider business mailing address

12711 TELGE RD STE #100
CYPRESS TX
77429
US

V. Phone/Fax

Practice location:
  • Phone: 832-930-7856
  • Fax:
Mailing address:
  • Phone: 832-930-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN ESCOBAR
Title or Position: OWNER
Credential: DDS
Phone: 832-930-7856