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General NPI Number Information
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NPI Number | 1689238289
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Entity Type | Organization
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Legal Business Name | VICKERS FAMILY DENTAL
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 13810 CHAMPION FOREST DR STE 204
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City | HOUSTON
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State | TX
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Zip | 77069-1868
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Country | US
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Telephone | 281-440-1200
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Fax | 281-440-3578
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Provider Business Mailing Address
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Address Line | PO BOX 11470
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City | SPRING
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State | TX
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Zip | 77391-1470
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Country | US
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Telephone | 281-440-1200
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Fax | 281-440-3578
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STEPHANIE ANN VICKERS
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Credential | RDA
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Telephone | 281-440-1200
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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 |
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License Number State |
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