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General NPI Number Information
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NPI Number | 1710008610
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Entity Type | Organization
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Legal Business Name | EVEREST DENTAL, PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 7312 LOUETTA RD B-119
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City | SPRING
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State | TX
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Zip | 77379-6175
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Country | US
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Telephone | 281-376-1735
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Fax |
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Provider Business Mailing Address
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Address Line | 7312 LOUETTA RD B-119
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City | SPRING
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State | TX
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Zip | 77379-6175
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Country | US
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Telephone | 281-376-1735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LONG V DO
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Credential | D.D.S
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Telephone | 832-274-9062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21221
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License Number State | TX
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