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General NPI Number Information
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NPI Number | 1588909956
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Entity Type | Organization
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Legal Business Name | DENTAL COSMETIC CENTER OF HOUSTON
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 4126 SOUTHWEST FWY SUITE 1610
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City | HOUSTON
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State | TX
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Zip | 77027-7310
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Country | US
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Telephone | 713-777-6453
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Fax | 713-850-7847
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Provider Business Mailing Address
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Address Line | 4126 SOUTHWEST FWY SUITE 1610
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City | HOUSTON
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State | TX
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Zip | 77027-7310
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Country | US
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Telephone | 713-777-6453
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Fax | 713-850-7847
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. RONALD JENARD MOON
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Credential | DDS
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Telephone | 712-777-6453
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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 | 19552
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License Number State | TX
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