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General NPI Number Information
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NPI Number | 1396514337
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Entity Type | Organization
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Legal Business Name | STELLENWERF DENTAL STUDIO
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 2325 TIMBER SHADOWS DR BLDG A
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City | KINGWOOD
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State | TX
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Zip | 77339-2028
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Country | US
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Telephone | 281-570-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 BROWNING ST
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City | HOUSTON
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State | TX
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Zip | 77005-2042
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VIVIANA STELLENWERF
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Credential | DDS
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Telephone | 281-570-6886
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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 |
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License Number State |
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