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General NPI Number Information
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NPI Number | 1427146463
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Entity Type | Organization
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Legal Business Name | WEST LAKE COLONNADE DENTAL, PLLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18477 W LAKE HOUSTON PKWY SUITE 80
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City | HUMBLE
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State | TX
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Zip | 77346-3517
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Country | US
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Telephone | 281-812-3333
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Fax | 281-812-3332
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Provider Business Mailing Address
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Address Line | 18477 W LAKE HOUSTON PKWY SUITE 80
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City | HUMBLE
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State | TX
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Zip | 77346-3517
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Country | US
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Telephone | 281-812-3333
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Fax | 281-812-3332
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | DR. BRANDY MICHELLE BURNETT
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Credential | D.D.S.
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Telephone | 281-812-3333
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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 | 21713
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License Number State | TX
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