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General NPI Number Information
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NPI Number | 1285829069
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Entity Type | Organization
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Legal Business Name | TARA DENTAL
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 6910 BELLAIRE BLVD BLVD #11
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City | HOUSTON
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State | TX
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Zip | 77074-3509
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Country | US
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Telephone | 713-988-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 BELLAIRE BLVD BLVD #11
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City | HOUSTON
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State | TX
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Zip | 77074-3509
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Country | US
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Telephone | 713-988-8272
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. OM KRISHAN
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Credential |
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Telephone | 713-988-8272
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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 | 20601
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License Number State | TX
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