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General NPI Number Information
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NPI Number | 1578940102
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Entity Type | Organization
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Legal Business Name | SPECDENT PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 6430 RICHMOND AVE SUITE 110
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City | HOUSTON
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State | TX
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Zip | 77057-5917
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Country | US
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Telephone | 832-930-4075
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Fax | 832-930-4079
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Provider Business Mailing Address
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Address Line | 6430 RICHMOND AVE SUITE 110
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City | HOUSTON
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State | TX
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Zip | 77057-5917
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Country | US
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Telephone | 832-930-4075
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Fax | 832-930-4079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A RASSNER
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Credential | DDS
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Telephone | 832-930-4075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 27441
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 24568
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16793
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License Number State | TX
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