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General NPI Number Information
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NPI Number | 1720417488
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Entity Type | Organization
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Legal Business Name | MAURELI INC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 4747 BELLAIRE BLVD SUITE 395
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City | BELLAIRE
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State | TX
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Zip | 77401-4527
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Country | US
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Telephone | 713-636-9734
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 BELLAIRE BLVD SUITE 395
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City | BELLAIRE
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State | TX
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Zip | 77401-4527
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Country | US
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Telephone | 713-636-9734
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHARON MINOTT-WARREN
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Credential | DDS
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Telephone | 713-636-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 17294
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License Number State | TX
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