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General NPI Number Information
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NPI Number | 1396087524
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Entity Type | Organization
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Legal Business Name | PORTAL FAMILY DENTISTRY & ORTHODONTICS PLLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 2710 N MASON RD
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City | KATY
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State | TX
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Zip | 77449-4176
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Country | US
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Telephone | 832-350-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 N MASON RD
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City | KATY
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State | TX
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Zip | 77449-4176
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Country | US
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Telephone | 832-350-4150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. GABRIELA M REINHOLTZ
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Credential |
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Telephone | 832-350-4150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 24823
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License Number State | TX
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