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General NPI Number Information
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NPI Number | 1407267933
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD DENTISTS ONE
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 12620 WOODFOREST BLVD STE 420A
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City | HOUSTON
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State | TX
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Zip | 77015-3643
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Country | US
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Telephone | 713-637-8000
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Fax | 713-637-6558
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Provider Business Mailing Address
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Address Line | 12620 WOODFOREST BLVD STE 420A
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City | HOUSTON
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State | TX
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Zip | 77015-3643
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Country | US
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Telephone | 713-637-8000
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Fax | 713-637-6558
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANH MAI
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Credential |
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Telephone | 281-589-1111
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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 | 27338
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License Number State | TX
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