Healthcare Provider Details

I. General information

NPI: 1275966780
Provider Name (Legal Business Name): JUST BRACES OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 N SAM HOUSTON PKWY E 160
HUMBLE TX
77396-4399
US

IV. Provider business mailing address

9025 N SAM HOUSTON PKWY E 160
HUMBLE TX
77396-4399
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-5551
  • Fax:
Mailing address:
  • Phone: 281-359-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23564
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number23564
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23564
License Number StateTX

VIII. Authorized Official

Name: SHUNDA THOMPSON BANKS
Title or Position: OWNER
Credential: DDS
Phone: 713-775-2888