Healthcare Provider Details

I. General information

NPI: 1427330596
Provider Name (Legal Business Name): TEXAS DENTAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 SOUTH HIGHWAY 6 SUITE 400
MISSOURI CITY TX
77459-4765
US

IV. Provider business mailing address

2536 AMHERST ST SUITE A
HOUSTON TX
77005-3207
US

V. Phone/Fax

Practice location:
  • Phone: 713-490-8880
  • Fax: 713-490-6464
Mailing address:
  • Phone: 713-490-8880
  • Fax: 713-490-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10849
License Number StateTX

VIII. Authorized Official

Name: DR. KENT E. ZIEGENBEIN
Title or Position: OWNER/GENERAL DENTIST
Credential: DDS
Phone: 713-490-8880