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General NPI Number Information
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NPI Number | 1053668137
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Entity Type | Organization
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Legal Business Name | C.C. TREJO D.D.S., P.A.
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 2600 S GESSNER RD SUITE 304
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City | HOUSTON
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State | TX
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Zip | 77063-3200
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Country | US
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Telephone | 713-785-4867
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Fax | 713-785-1191
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Provider Business Mailing Address
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Address Line | 2600 S GESSNER RD SUITE 304
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City | HOUSTON
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State | TX
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Zip | 77063-3200
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Country | US
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Telephone | 713-785-4867
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Fax | 713-785-1191
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. CORLETTA TREJO
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Credential | DDS
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Telephone | 713-785-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 19095
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17954
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License Number State | TX
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