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General NPI Number Information
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NPI Number | 1154690782
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Entity Type | Organization
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Legal Business Name | SANDEEP P. MAMMEN, D.M.D., P.C.
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 7324 SOUTHWEST FWY SUITE 490
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City | HOUSTON
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State | TX
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Zip | 77074-2012
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Country | US
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Telephone | 713-777-1774
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Fax | 713-777-7137
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Provider Business Mailing Address
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Address Line | 7324 SOUTHWEST FWY SUITE 490
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City | HOUSTON
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State | TX
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Zip | 77074-2012
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Country | US
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Telephone | 713-777-1774
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Fax | 713-777-7137
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANDEEP P MAMMEN
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Credential | DMD
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Telephone | 713-777-1774
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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 | 23225
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License Number State | TX
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