Healthcare Provider Details

I. General information

NPI: 1780056887
Provider Name (Legal Business Name): ASSOCIATES FOR DENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9533 KIRBY DR
HOSUTON TX
77074
US

IV. Provider business mailing address

6137 KIRBY DR
HOUSTON TX
77005-3148
US

V. Phone/Fax

Practice location:
  • Phone: 281-738-1579
  • Fax: 713-490-6464
Mailing address:
  • Phone: 713-490-8888
  • Fax: 713-490-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6626
License Number StateTX

VIII. Authorized Official

Name: DONALD WAYNE ANDRESS
Title or Position: OWNER
Credential: DDS
Phone: 281-738-1579