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General NPI Number Information
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NPI Number | 1023831310
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Entity Type | Organization
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Legal Business Name | EADO FAMILY DENTAL - NORTHSIDE PLLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1102 PINEMONT DR STE I
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City | HOUSTON
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State | TX
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Zip | 77018-1323
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Country | US
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Telephone | 917-331-3281
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 CLAY ST
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City | HOUSTON
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State | TX
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Zip | 77003-4516
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Country | US
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Telephone | 917-331-3281
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN WILSON MA
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Credential |
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Telephone | 917-331-3281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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