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General NPI Number Information
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NPI Number | 1467776591
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Entity Type | Organization
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Legal Business Name | BRIAR FOREST DENTAL GROUP
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1988 WILCREST DR SUITE G
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City | HOUSTON
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State | TX
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Zip | 77042-2638
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Country | US
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Telephone | 713-784-4430
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Fax | 713-784-0101
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Provider Business Mailing Address
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Address Line | 1988 WILCREST DR. SUITE G
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City | HOUSTON
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State | TX
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Zip | 77042
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Country | US
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Telephone | 713-784-4430
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Fax | 713-784-0101
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEMETRA ARCENEAUX
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Credential |
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Telephone | 713-784-4430
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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 | 22353
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21468
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22419
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License Number State | TX
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