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General NPI Number Information
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NPI Number | 1437473154
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Entity Type | Organization
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Legal Business Name | CEJ DENTAL CENTER LLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 11595 WILCREST SUITE B
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City | HOUSTON
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State | TX
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Zip | 77099
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Country | US
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Telephone | 281-983-5200
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Fax | 281-983-5204
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Provider Business Mailing Address
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Address Line | 11595 WILCREST SUITE B
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City | HOUSTON
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State | TX
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Zip | 77099
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Country | US
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Telephone | 281-983-5200
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Fax | 281-983-5204
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MS. CRISTINA RODRIGUEZ
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Credential | D.D.S.
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Telephone | 281-983-5200
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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 | 23443
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23417
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21866
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License Number State | TX
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