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General NPI Number Information
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NPI Number | 1427368455
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Entity Type | Organization
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Legal Business Name | MARY ANN GRACE SAGULLO DDS PC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 304 E TIDWELL RD
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City | HOUSTON
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State | TX
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Zip | 77022-1624
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Country | US
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Telephone | 713-367-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 304 E TIDWELL RD
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City | HOUSTON
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State | TX
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Zip | 77022-1624
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Country | US
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Telephone | 713-367-0290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY ANN GRACE SAGULLO
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Credential | DDS
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Telephone | 713-367-0290
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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 | 20093
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License Number State | TX
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