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General NPI Number Information
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NPI Number | 1073078093
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Entity Type | Organization
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Legal Business Name | GIVAN FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 4557 E SAM HOUSTON PKWY S
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City | PASADENA
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State | TX
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Zip | 77505-3994
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Country | US
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Telephone | 404-488-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 WATERS EDGE CT
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City | PEARLAND
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State | TX
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Zip | 77584-8207
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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 | OWNER DENTIST
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Name | CARLA GIVAN
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Credential | DDS
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Telephone | 404-488-4493
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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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