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General NPI Number Information
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NPI Number | 1487704771
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Entity Type | Organization
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Legal Business Name | JASMINE DENTAL AT SILVERLAKE, PA
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 339 W PARKWOOD AVE
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5424
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Country | US
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Telephone | 281-993-1299
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Fax | 281-993-1960
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Provider Business Mailing Address
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Address Line | 339 W PARKWOOD AVE
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5424
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Country | US
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Telephone | 281-993-1299
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Fax | 281-993-1960
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY HUYNH HICKS
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Credential | D.D.S.
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Telephone | 281-993-1299
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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 | 19820
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License Number State | TX
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