=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336274521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ENDODONTICS OF HOUSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 02/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 SAN FELIPE STE. 320
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-1613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-266-5900
-----------------------------------------------------
Fax | 713-266-1080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7700 SAN FELIPE STE. 320
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-1613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-266-5900
-----------------------------------------------------
Fax | 713-266-1080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. PATRICIA GUERRERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-266-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 19683
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------