Healthcare Provider Details

I. General information

NPI: 1790249803
Provider Name (Legal Business Name): FMS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 SOUTHWEST FWY # 190
HOUSTON TX
77098-4609
US

IV. Provider business mailing address

2615 SOUTHWEST FWY # 190
HOUSTON TX
77098-4609
US

V. Phone/Fax

Practice location:
  • Phone: 713-364-1616
  • Fax:
Mailing address:
  • Phone: 713-364-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN LEE
Title or Position: MANAGER
Credential: DDS
Phone: 213-249-6182