Healthcare Provider Details

I. General information

NPI: 1356586986
Provider Name (Legal Business Name): ORTHODONTICS AND COSMETIC DENTISTRY HOUSTON GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25326 OAKHURST DR
SPRING TX
77386-1425
US

IV. Provider business mailing address

PO BOX 8577
SPRING TX
77387-8577
US

V. Phone/Fax

Practice location:
  • Phone: 832-616-3117
  • Fax:
Mailing address:
  • Phone: 832-616-3117
  • Fax: 832-616-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23149
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23149
License Number StateTX

VIII. Authorized Official

Name: DR. RAFAEL FRANCISCO DIAZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 832-616-3117