Healthcare Provider Details

I. General information

NPI: 1730599390
Provider Name (Legal Business Name): TEXAS DENTAL ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 SOUTHWEST FWY STE 570
SUGAR LAND TX
77479-2321
US

IV. Provider business mailing address

2536 AMHERST ST STE. A
HOUSTON TX
77005-3207
US

V. Phone/Fax

Practice location:
  • Phone: 281-456-8388
  • Fax: 713-490-6464
Mailing address:
  • Phone: 713-490-8880
  • Fax: 713-490-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KENT ZIEGENBEIN
Title or Position: OWNER
Credential: DDS
Phone: 713-490-8880