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General NPI Number Information
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NPI Number | 1225493687
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Entity Type | Organization
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Legal Business Name | SKKZ, INC.
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 6415 FAIRMONT PKWY STE A
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City | PASADENA
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State | TX
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Zip | 77505
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Country | US
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Telephone | 281-998-0022
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Fax | 281-998-3016
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Provider Business Mailing Address
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Address Line | 6415 FAIRMONT PKWY SUITE A
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City | PASADENA
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State | TX
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Zip | 77505
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Country | US
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Telephone | 281-998-0022
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Fax | 281-998-3016
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Authorized Official
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Title or Position | DENTIST
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Name | SHAWNA D'ANN BLAND-TREGRE
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Credential | D.D.S.
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Telephone | 281-998-0022
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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 |
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License Number State |
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