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General NPI Number Information
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NPI Number | 1154865442
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Entity Type | Organization
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Legal Business Name | CHETWOOD DENTAL CLINIC PLLC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 6910 CHETWOOD DR STE C
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City | HOUSTON
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State | TX
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Zip | 77081-5612
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Country | US
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Telephone | 281-451-7886
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 COTTAGE LANDING LN
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City | HOUSTON
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State | TX
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Zip | 77077-1923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAN DOAN
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Credential |
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Telephone | 281-451-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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