=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629374673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE DENTAL DESING STUDIOS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2011
-----------------------------------------------------
Last Update Date | 05/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9809 ROWLETT RD SUITE B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77075-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-426-4076
-----------------------------------------------------
Fax | 832-623-6553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10497 TOWN AND COUNTRY WAY SUITE 914
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-5800
-----------------------------------------------------
Fax | 713-468-2881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | IVIS ARGUELLES HERNANDEZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-468-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 17143
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------