=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134434558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTAL DENTAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 08/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12035B BAMMEL NORTH HOUSTON RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-593-1101
-----------------------------------------------------
Fax | 713-979-3674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12035B BAMMEL NORTH HOUSTON RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-593-1101
-----------------------------------------------------
Fax | 713-979-3674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | DR. GABRIELA M REINHOLTZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 773-593-1101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 24823
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------