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General NPI Number Information
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NPI Number | 1336366533
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Entity Type | Organization
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Legal Business Name | YD GREENLIGHT
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7333 NORTH FWY SUITE 300
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City | HOUSTON
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State | TX
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Zip | 77076-1300
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Country | US
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Telephone | 713-691-4300
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Fax | 713-691-4461
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Provider Business Mailing Address
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Address Line | 7333 NORTH FWY SUITE 300
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City | HOUSTON
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State | TX
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Zip | 77076-1300
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Country | US
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Telephone | 713-691-4300
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Fax | 713-691-4461
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | MRS. BLANCA URBINA
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Credential |
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Telephone | 713-691-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22078
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License Number State | TX
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