Healthcare Provider Details

I. General information

NPI: 1962264226
Provider Name (Legal Business Name): 290 CROSSING DENTAL AND ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7844 W TIDWELL RD STE 130
HOUSTON TX
77040-5862
US

IV. Provider business mailing address

8505 FREEPORT PKWY STE 600
IRVING TX
75063-2549
US

V. Phone/Fax

Practice location:
  • Phone: 817-529-8151
  • Fax: 817-529-5159
Mailing address:
  • Phone: 817-529-8151
  • Fax: 817-529-8159

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: DR. RAFFY KOUYOUMDJIAN
Title or Position: OWNER
Credential: DMD
Phone: 818-653-9799