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General NPI Number Information
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NPI Number | 1720567274
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Entity Type | Organization
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Legal Business Name | SEA LOTUS DENTISTRY PLLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 3422 BUSINESS CENTER DRIVE, SUITE 116
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City | PEARLAND
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State | TX
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Zip | 77584
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Country | US
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Telephone | 832-930-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 3422 BUSINESS CENTER DR STE 116
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City | PEARLAND
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State | TX
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Zip | 77584-4148
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Country | US
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Telephone | 832-930-7755
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Fax | 281-416-4064
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SOPHIE DOAN
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Credential |
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Telephone | 832-930-7755
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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 |
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License Number State |
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