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General NPI Number Information
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NPI Number | 1538603071
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Entity Type | Organization
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Legal Business Name | JJJ DENTAL PC
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 11403 BARKER CYPRESS RD STE 1300
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City | CYPRESS
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State | TX
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Zip | 77433-5425
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Country | US
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Telephone | 281-318-5521
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Fax | 800-507-8712
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Provider Business Mailing Address
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Address Line | 11403 BARKER CYPRESS RD STE 1300
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City | CYPRESS
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State | TX
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Zip | 77433-5425
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Country | US
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Telephone | 281-318-5521
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Fax | 800-507-8712
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MOLLISA ROMERO
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Credential |
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Telephone | 602-652-2257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29063
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License Number State | TX
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