Healthcare Provider Details

I. General information

NPI: 1750480661
Provider Name (Legal Business Name): ALLEN F GAW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 MANGUM RD STE 109
HOUSTON TX
77092-7404
US

IV. Provider business mailing address

2710 MANGUM RD STE 109
HOUSTON TX
77092-7404
US

V. Phone/Fax

Practice location:
  • Phone: 713-956-0400
  • Fax: 713-956-7617
Mailing address:
  • Phone: 713-956-0400
  • Fax: 713-956-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11081
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: