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General NPI Number Information
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NPI Number | 1053883884
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Entity Type | Organization
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Legal Business Name | NORTHSHORE DENTAL
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 2 EVANSTON ST
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City | HOUSTON
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State | TX
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Zip | 77015-1616
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Country | US
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Telephone | 713-453-7466
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Fax |
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Provider Business Mailing Address
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Address Line | 2 EVANSTON ST
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City | HOUSTON
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State | TX
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Zip | 77015-1616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE ADMINISTRATOR
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Name | SARAH STETSON
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Credential |
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Telephone | 713-453-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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