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General NPI Number Information
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NPI Number | 1003205485
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALISTS OF TOMBALL, PLLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 1123 ALMA ST
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City | TOMBALL
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State | TX
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Zip | 77375-4518
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Country | US
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Telephone | 281-351-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 ALMA ST
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City | TOMBALL
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State | TX
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Zip | 77375-4518
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Country | US
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Telephone | 281-351-2200
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. BRAD BOWSHER
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Credential |
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Telephone | 281-351-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 19953
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21280
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License Number State | TX
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