Healthcare Provider Details

I. General information

NPI: 1316598006
Provider Name (Legal Business Name): VMD RSVJR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11391 VETERANS MEMORIAL DR
HOUSTON TX
77067-3800
US

IV. Provider business mailing address

11391 VETERANS MEMORIAL DR
HOUSTON TX
77067-3800
US

V. Phone/Fax

Practice location:
  • Phone: 214-493-1216
  • Fax: 214-242-2006
Mailing address:
  • Phone: 214-493-1216
  • Fax: 214-242-2006

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: NINA ABTAHI
Title or Position: MANAGER
Credential:
Phone: 214-493-1216