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General NPI Number Information
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NPI Number | 1538795745
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Entity Type | Organization
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Legal Business Name | CAVITY PATROL PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 7914 FRY ROAD SUITE 280
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City | CYPRESS
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State | TX
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Zip | 77433
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Country | US
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Telephone | 832-305-6507
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Fax |
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Provider Business Mailing Address
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Address Line | 7914 FRY RD STE 280
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City | CYPRESS
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State | TX
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Zip | 77433-3214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHUN YIN WONG
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Credential | DMD
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Telephone | 832-305-6507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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