Healthcare Provider Details

I. General information

NPI: 1154690782
Provider Name (Legal Business Name): SANDEEP P. MAMMEN, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 SOUTHWEST FWY SUITE 490
HOUSTON TX
77074-2012
US

IV. Provider business mailing address

7324 SOUTHWEST FWY SUITE 490
HOUSTON TX
77074-2012
US

V. Phone/Fax

Practice location:
  • Phone: 713-777-1774
  • Fax: 713-777-7137
Mailing address:
  • Phone: 713-777-1774
  • Fax: 713-777-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number23225
License Number StateTX

VIII. Authorized Official

Name: DR. SANDEEP P MAMMEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 713-777-1774