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General NPI Number Information
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NPI Number | 1134500317
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Entity Type | Individual
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Provider Name | LORRAINE BAUTISTA-NGO DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2015
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 24179 STATE HIGHWAY 249 STE B
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City | TOMBALL
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State | TX
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Zip | 77375-8299
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Country | US
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Telephone | 281-357-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 14322 ARDWELL DR
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City | SUGAR LAND
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State | TX
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Zip | 77498-5106
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Country | US
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Telephone | 832-877-7201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 30958
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License Number State | TX
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