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General NPI Number Information
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NPI Number | 1164157541
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Entity Type | Organization
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Legal Business Name | NATIONAL DENTAL CARE PLLC
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 02/12/2023
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Provider Practice Location Address
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Address Line | 12235 QUEENSTON BLVD
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City | HOUSTON
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State | TX
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Zip | 77095
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Country | US
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Telephone | 626-848-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 12235 QUEENSTON BLVD STE C
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City | HOUSTON
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State | TX
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Zip | 77095-5333
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Country | US
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Telephone | 832-930-7758
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WAN LING TAN
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Credential | DDS
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Telephone | 832-930-7758
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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 |
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License Number State |
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