Healthcare Provider Details

I. General information

NPI: 1710672209
Provider Name (Legal Business Name): ROSENBERG DENTAL AND IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 AVENUE I
ROSENBERG TX
77471-3622
US

IV. Provider business mailing address

2818 AVENUE I
ROSENBERG TX
77471-3622
US

V. Phone/Fax

Practice location:
  • Phone: 281-341-6680
  • Fax:
Mailing address:
  • Phone: 281-341-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL COLLINS
Title or Position: DOCTOR
Credential: DDS
Phone: 281-341-6680