Healthcare Provider Details

I. General information

NPI: 1366882268
Provider Name (Legal Business Name): CYNTHIA CORRAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WASHINGTON AVE STE 201
HOUSTON TX
77007-5673
US

IV. Provider business mailing address

19934 HICKORY WIND DR
HUMBLE TX
77346-2153
US

V. Phone/Fax

Practice location:
  • Phone: 713-518-1411
  • Fax:
Mailing address:
  • Phone: 281-536-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: