Healthcare Provider Details

I. General information

NPI: 1518063924
Provider Name (Legal Business Name): WOODFOREST DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FREEPORT ST
HOUSTON TX
77015-4083
US

IV. Provider business mailing address

625 FREEPORT ST
HOUSTON TX
77015-4083
US

V. Phone/Fax

Practice location:
  • Phone: 713-455-1613
  • Fax: 713-455-5529
Mailing address:
  • Phone: 713-455-1613
  • Fax: 713-455-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9788
License Number StateTX

VIII. Authorized Official

Name: DONALD A HALBARDIER
Title or Position: OWNER
Credential: DDS
Phone: 281-440-0814