Healthcare Provider Details

I. General information

NPI: 1942668405
Provider Name (Legal Business Name): EADO FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 NAVIGATION BLVD SUITE 300
HOUSTON TX
77003
US

IV. Provider business mailing address

2221 W DALLAS ST #230
HOUSTON TX
77019-4386
US

V. Phone/Fax

Practice location:
  • Phone: 516-330-5131
  • Fax:
Mailing address:
  • Phone: 516-330-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29748
License Number StateTX

VIII. Authorized Official

Name: DR. BIANCA MARIE WILLIAMS
Title or Position: MANAGING MEMBER
Credential: D.D.S.
Phone: 516-330-5131