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General NPI Number Information
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NPI Number | 1730550161
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Entity Type | Organization
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Legal Business Name | TLN FAMILY & COSMETIC DENTAL @ PEARLAND PARKWAY
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 2701 PEARLAND PARKWAY SUITE 201
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 713-723-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 63 GENOVA WAY LANE
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City | MISSOURI CITY
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State | TX
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Zip | 77459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TAMMEKA NICKLEBERRY
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Credential | DDS
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Telephone | 713-723-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 22283
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License Number State | TX
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