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General NPI Number Information
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NPI Number | 1093948044
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Entity Type | Organization
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Legal Business Name | MGMDDS
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 13810 JOHN AUDUBON PKWY STE A
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City | WEBSTER
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State | TX
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Zip | 77598-3862
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Country | US
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Telephone | 281-486-9222
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Fax | 281-486-8700
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Provider Business Mailing Address
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Address Line | 13810 JOHN AUDUBON PKWY STE A
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City | WEBSTER
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State | TX
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Zip | 77598-3862
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Country | US
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Telephone | 281-486-9222
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Fax | 281-486-8700
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MICHAEL G MOORE
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Credential | D.D.S.
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Telephone | 281-486-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17826
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License Number State | TX
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