Healthcare Provider Details

I. General information

NPI: 1942928502
Provider Name (Legal Business Name): PERIODONTAL CENTER OF EXCELLENCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GROGANS PARK DR STE 103
SPRING TX
77380-2937
US

IV. Provider business mailing address

3 GROGANS PARK DR STE 103
SPRING TX
77380-2937
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-1833
  • Fax:
Mailing address:
  • Phone: 281-292-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI SAAM SAJADI
Title or Position: MANAGING PARTNER
Credential: DDS MSD
Phone: 832-452-8625