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General NPI Number Information
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NPI Number | 1679365233
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Entity Type | Organization
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Legal Business Name | SPRINGWOODS VILLAGE DENTAL GROUP
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 2255 EAST MOSSY OAKS RD SUITE 640
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City | SPRING
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State | TX
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Zip | 77389-1768
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Country | US
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Telephone | 281-547-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 EAST MOSSY OAKS RD SUITE 640
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City | SPRING
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State | TX
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Zip | 77389-1768
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Country | US
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Telephone | 281-547-0101
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Fax |
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Authorized Official
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Title or Position | S CORP OWNER
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Name | CHRISTINA MICHELLE CLARK
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Credential | DDS
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Telephone | 253-254-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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