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General NPI Number Information
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NPI Number | 1083750285
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Entity Type | Organization
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Legal Business Name | WASHINGTON DENTAL
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 2515 WASHINGTON AVE
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City | HOUSTON
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State | TX
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Zip | 77007-6342
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Country | US
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Telephone | 713-802-0044
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Fax | 713-802-2162
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Provider Business Mailing Address
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Address Line | 2515 WASHINGTON AVE
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City | HOUSTON
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State | TX
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Zip | 77007-6342
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Country | US
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Telephone | 713-802-0044
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Fax | 713-802-2162
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAURICIO TOVAR
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Credential | D.D.S.
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Telephone | 713-802-0044
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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 | 17000
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License Number State | TX
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