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General NPI Number Information
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NPI Number | 1528626462
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Entity Type | Organization
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Legal Business Name | NOTTINGHAM DENTAL PLLC
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 20501 KATY FWY, STE 104
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City | KATY
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State | TX
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Zip | 77450-1939
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Country | US
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Telephone | 281-578-0211
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Fax | 281-578-2457
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Provider Business Mailing Address
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Address Line | 20501 KATY FWY, STE 104
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City | KATY
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State | TX
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Zip | 77450-1939
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Country | US
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Telephone | 281-578-0211
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Fax | 281-578-2457
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Authorized Official
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Title or Position | MEMBER
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Name | JINGRU YAN
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Credential | DDS
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Telephone | 281-578-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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