Healthcare Provider Details

I. General information

NPI: 1164092839
Provider Name (Legal Business Name): ALFI ORAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 FANNIN ST STE 1710
HOUSTON TX
77030-2329
US

IV. Provider business mailing address

6624 FANNIN ST STE 1710
HOUSTON TX
77030-2329
US

V. Phone/Fax

Practice location:
  • Phone: 844-253-4667
  • Fax: 844-253-4667
Mailing address:
  • Phone: 844-253-4667
  • Fax: 844-253-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JULIE PHAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 832-537-9930