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General NPI Number Information
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NPI Number | 1356218804
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Entity Type | Organization
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Legal Business Name | THE TOOTH LODGE
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 6820 FM 2920 STE 190
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City | SPRING
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State | TX
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Zip | 77379
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Country | US
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Telephone | 346-298-7679
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Fax | 346-298-7680
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Provider Business Mailing Address
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Address Line | 16411 WELLERS WAY
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City | HOUSTON
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State | TX
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Zip | 77095-3937
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Country | US
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Telephone | 832-312-1794
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | AFREEN ANSARI
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Credential | DDS
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Telephone | 346-298-7679
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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 |
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License Number State |
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