Healthcare Provider Details

I. General information

NPI: 1043225428
Provider Name (Legal Business Name): JULIO RAFAEL GAITAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 WESTHEIMER #1
HOUSTON TX
77063
US

IV. Provider business mailing address

1200 POST OAK BLVD. #2206
HOUSTON TX
77056
US

V. Phone/Fax

Practice location:
  • Phone: 713-932-7730
  • Fax:
Mailing address:
  • Phone: 713-623-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number19953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: