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General NPI Number Information
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NPI Number | 1528557998
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Entity Type | Organization
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Legal Business Name | MEMORIAL DENTAL CARE, PLLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 14441 MEMORIAL DR STE 11
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City | HOUSTON
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State | TX
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Zip | 77079-6737
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Country | US
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Telephone | 281-493-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 14441 MEMORIAL DR STE 11
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City | HOUSTON
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State | TX
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Zip | 77079-6737
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Country | US
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Telephone | 281-493-1550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAMERON WALLACE
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Credential | DDS
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Telephone | 817-235-4625
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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 | 23910
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License Number State | TX
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