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General NPI Number Information
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NPI Number | 1518799626
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Entity Type | Organization
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Legal Business Name | KATY PERIODONTICS MANAGEMENT INC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 810 S. MASON RD. STE. 325
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City | KATY
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State | TX
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Zip | 77450-3858
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Country | US
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Telephone | 281-392-6000
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Fax | 281-392-6811
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Provider Business Mailing Address
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Address Line | 810 S. MASON RD. STE. 325
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City | KATY
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State | TX
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Zip | 77450-3858
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Country | US
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Telephone | 281-392-6000
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Fax | 281-392-6811
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY MICHAEL HALE
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Credential | DDS
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Telephone | 281-392-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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