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General NPI Number Information
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NPI Number | 1518471432
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Entity Type | Organization
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Legal Business Name | KATY GENTLE DENTISTS, P.A.
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 22026 HIGHLAND KNOLLS DR
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City | KATY
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State | TX
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Zip | 77450-5859
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Country | US
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Telephone | 281-693-6400
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Fax | 281-693-6404
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Provider Business Mailing Address
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Address Line | 22026 HIGHLAND KNOLLS DR
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City | KATY
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State | TX
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Zip | 77450-5859
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Country | US
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Telephone | 281-693-6400
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Fax | 281-693-6404
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Authorized Official
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Title or Position | DENTIST
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Name | MARYAM SHARIFF
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Credential | DMD
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Telephone | 281-693-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 28232
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License Number State | TX
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