Healthcare Provider Details

I. General information

NPI: 1598955593
Provider Name (Legal Business Name): AMANDA JUAREZ, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 POST OAK BLVD #1620
HOUSTON TX
77056
US

IV. Provider business mailing address

1300 POST OAK BLVD #1620
HOUSTON TX
77056
US

V. Phone/Fax

Practice location:
  • Phone: 480-250-7327
  • Fax:
Mailing address:
  • Phone: 480-250-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25163
License Number StateTX

VIII. Authorized Official

Name: DR. AMANDA K JUAREZ
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 480-250-7327