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General NPI Number Information
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NPI Number | 1417647405
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Entity Type | Organization
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Legal Business Name | SOUTH PEEK DENTAL CARE PLLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 6356 S PEEK RD STE 700
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City | KATY
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State | TX
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Zip | 77450-7192
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Country | US
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Telephone | 714-622-9620
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Fax | 346-307-7359
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Provider Business Mailing Address
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Address Line | 6356 S PEEK RD STE 700
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City | KATY
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State | TX
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Zip | 77450-7192
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Country | US
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Telephone | 714-622-9620
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Fax | 346-307-7359
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER NGUYEN
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Credential | DMD
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Telephone | 714-622-9620
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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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