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General NPI Number Information
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NPI Number | 1184970410
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Entity Type | Organization
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Legal Business Name | AMYMORAN DDS, PC
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 820 GESSNER RD 1560
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City | HOUSTON
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State | TX
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Zip | 77024-4289
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Country | US
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Telephone | 832-563-9592
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 EIGEL ST A
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City | HOUSTON
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State | TX
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Zip | 77007-3276
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Country | US
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Telephone | 832-563-9592
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY VLACHAKIS
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Credential | DDS
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Telephone | 832-563-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24057
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License Number State | TX
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