Healthcare Provider Details

I. General information

NPI: 1295334803
Provider Name (Legal Business Name): JPM DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/18/2021
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 FM 1960 RD W STE G
HOUSTON TX
77069-3701
US

IV. Provider business mailing address

17723 LUMINAIRE LN
RICHMOND TX
77407-7932
US

V. Phone/Fax

Practice location:
  • Phone: 713-385-3019
  • Fax:
Mailing address:
  • Phone: 713-375-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PRANAV MODY
Title or Position: OWNER
Credential: DDS
Phone: 713-385-3019