Healthcare Provider Details

I. General information

NPI: 1750760179
Provider Name (Legal Business Name): VILLAGE PARK FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12617 LOUETTA RD STE 204
CYPRESS TX
77429-5212
US

IV. Provider business mailing address

12617 LOUETTA RD STE 204
CYPRESS TX
77429-5212
US

V. Phone/Fax

Practice location:
  • Phone: 281-336-1131
  • Fax: 888-433-8848
Mailing address:
  • Phone: 281-336-1131
  • Fax: 888-433-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23508
License Number StateTX

VIII. Authorized Official

Name: DR. SABA AHMED
Title or Position: DOCTOR
Credential: DDS
Phone: 218-336-1131