Healthcare Provider Details

I. General information

NPI: 1467432575
Provider Name (Legal Business Name): FOUAT BEND DENTAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 TOWNSHIP LANE
MISSOURI CITY TX
77459
US

IV. Provider business mailing address

3717 TOWNSHIP LANE
MISSOURI CITY TX
77459
US

V. Phone/Fax

Practice location:
  • Phone: 281-499-3541
  • Fax: 281-605-5956
Mailing address:
  • Phone: 281-499-3541
  • Fax: 281-499-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MR. DWIGHT D PECCORA
Title or Position: DOCTOR/MANAGING PARTNER
Credential: DDS
Phone: 281-499-3541