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General NPI Number Information
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NPI Number | 1497130843
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Entity Type | Organization
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Legal Business Name | TEXAS FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 910 S WAYSIDE DR STE 300
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City | HOUSTON
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State | TX
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Zip | 77023-3417
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Country | US
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Telephone | 832-433-7252
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Fax | 832-668-5447
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Provider Business Mailing Address
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Address Line | 1919 LAKE WINDS DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1710
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Country | US
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Telephone | 832-433-7252
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. SHERVIN AMINI
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Credential |
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Telephone | 713-465-8239
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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