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General NPI Number Information
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NPI Number | 1235994864
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Entity Type | Organization
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Legal Business Name | SUGAR LAND PERIOCOSMETIC DENTAL PLLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2941 BROADWAY BEND DR STE 206
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City | PEARLAND
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State | TX
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Zip | 77584-2291
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Country | US
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Telephone | 832-620-9131
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17029
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City | SUGAR LAND
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State | TX
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Zip | 77496-7029
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Country | US
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Telephone | 832-620-9131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZHIJIAN CHEN
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Credential | DDS, MS
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Telephone | 832-620-9131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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