Healthcare Provider Details

I. General information

NPI: 1821786013
Provider Name (Legal Business Name): GRIN DENTAL AND ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3648 CYPRESS PARKWAY SUITE 246
HOUSTON TX
77068-3648
US

IV. Provider business mailing address

3648 CYPRESS PARKWAY SUITE 246
HOUSTON TX
77068-3648
US

V. Phone/Fax

Practice location:
  • Phone: 832-271-3200
  • Fax:
Mailing address:
  • Phone: 832-271-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SHUNDA THOMPSON PRICE
Title or Position: PRINICPAL
Credential: DDS
Phone: 713-775-2888