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General NPI Number Information
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NPI Number | 1417198615
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Entity Type | Organization
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Legal Business Name | TLN FAMILY DENTAL PA
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 14522 S POST OAK RD SUITE 110A
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City | HOUSTON
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State | TX
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Zip | 77045-6037
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Country | US
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Telephone | 713-723-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5734 GASSER LN
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City | HOUSTON
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State | TX
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Zip | 77085-5200
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Country | US
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Telephone | 832-654-2143
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMMEKA LA KEISHA NICKLEBERRY
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Credential | D.D.S.
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Telephone | 832-654-2143
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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 | 22283
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License Number State | TX
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