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General NPI Number Information
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NPI Number | 1710239116
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Entity Type | Organization
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Legal Business Name | TOWN AND COUNTRY ORTHODONTICS
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 788 W SAM HOUSTON PKWY N SUITE #201
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City | HOUSTON
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State | TX
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Zip | 77024-3974
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Country | US
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Telephone | 713-465-3400
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Fax | 713-465-3401
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Provider Business Mailing Address
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Address Line | 788 W SAM HOUSTON PKWY N SUITE #201
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City | HOUSTON
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State | TX
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Zip | 77024-3974
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Country | US
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Telephone | 713-465-3400
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Fax | 713-465-3401
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. CARIN DOMANN
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Credential |
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Telephone | 713-465-3400
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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 | 22867
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23517
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License Number State | TX
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