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General NPI Number Information
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NPI Number | 1720882475
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Entity Type | Organization
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Legal Business Name | GRACE PERIO & IMPLANTS
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 13810 JOHN AUBUBON PKWY SUITE C
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City | WEBSTER
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State | TX
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Zip | 77546
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Country | US
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Telephone | 281-286-0056
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Fax |
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Provider Business Mailing Address
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Address Line | 13810 JOHN AUBUBON PKWY SUITE C
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City | WEBSTER
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State | TX
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Zip | 77546
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Country | US
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Telephone | 281-286-0056
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CAROL MILLER
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Credential |
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Telephone | 713-784-6065
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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 |
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License Number State |
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