Healthcare Provider Details

I. General information

NPI: 1669622312
Provider Name (Legal Business Name): SNAN LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 CHAMPION FOREST DRIVE BUILDING #5
HOUSTON TX
77069
US

IV. Provider business mailing address

13303 CHAMPION FOREST DRIVE BUILDING #5
HOUSTON TX
77069
US

V. Phone/Fax

Practice location:
  • Phone: 281-444-1755
  • Fax: 281-444-1314
Mailing address:
  • Phone: 281-444-1755
  • Fax: 281-444-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19369
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18759
License Number StateTX

VIII. Authorized Official

Name: DR. GEORGE E SALBA
Title or Position: MANAGING PARTNER
Credential: DDS
Phone: 281-444-1755