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General NPI Number Information
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NPI Number | 1497132328
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Entity Type | Organization
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Legal Business Name | ESGB, INC
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 514 HONEA EGYPT RD SUITE 200
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City | MAGNOLIA
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State | TX
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Zip | 77354-3399
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Country | US
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Telephone | 713-703-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 514 HONEA EGYPT RD SUITE 200
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City | MAGNOLIA
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State | TX
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Zip | 77354-3399
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Country | US
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Telephone | 713-703-0737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY S HARRIS
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Credential | D.M.D.
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Telephone | 713-703-0737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24481
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License Number State | TX
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