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General NPI Number Information
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NPI Number | 1467727347
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Entity Type | Organization
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Legal Business Name | SOUTH HOUSTON FAMILY DENTAL
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 701 COLLEGE AVE
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City | SOUTH HOUSTON
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State | TX
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Zip | 77587-4205
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Country | US
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Telephone | 713-941-7555
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Fax | 713-951-7527
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Provider Business Mailing Address
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Address Line | 701 COLLEGE AVE
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City | SOUTH HOUSTON
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State | TX
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Zip | 77587-4205
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Country | US
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Telephone | 713-941-7555
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Fax | 713-951-7527
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PRIYA T GANJU
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Credential | D.D.S.
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Telephone | 713-941-7555
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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 | 19772
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License Number State | TX
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