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General NPI Number Information
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NPI Number | 1568742641
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Entity Type | Organization
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Legal Business Name | JEFF TOLLETT DDS PA
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 7515 MAIN ST SUITE 710
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City | HOUSTON
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State | TX
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Zip | 77030-4519
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Country | US
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Telephone | 713-795-5951
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Fax | 713-795-5794
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Provider Business Mailing Address
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Address Line | 1011 AUGUSTA DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77057-2062
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Country | US
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Telephone | 713-622-3240
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Fax | 713-622-3280
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JEFFREY JOHN TOLLETT
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Credential | DDS
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Telephone | 713-622-3240
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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 | 27023
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License Number State | TX
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