Healthcare Provider Details

I. General information

NPI: 1497132328
Provider Name (Legal Business Name): ESGB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 HONEA EGYPT RD SUITE 200
MAGNOLIA TX
77354-3399
US

IV. Provider business mailing address

514 HONEA EGYPT RD SUITE 200
MAGNOLIA TX
77354-3399
US

V. Phone/Fax

Practice location:
  • Phone: 713-703-0737
  • Fax:
Mailing address:
  • Phone: 713-703-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number24481
License Number StateTX

VIII. Authorized Official

Name: DR. BRADLEY S HARRIS
Title or Position: OWNER
Credential: D.M.D.
Phone: 713-703-0737