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General NPI Number Information
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NPI Number | 1740717883
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Entity Type | Organization
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Legal Business Name | FAIRFIELD PROFESSIONAL LLC
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 28070 HIGHWAY 290 STE 150
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City | CYPRESS
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State | TX
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Zip | 77433-6921
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Country | US
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Telephone | 281-373-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 28070 HIGHWAY 290 STE 150
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City | CYPRESS
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State | TX
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Zip | 77433-6921
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Country | US
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Telephone | 281-373-4000
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TANYA AMADOR
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Credential |
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Telephone | 713-694-8800
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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 | 19674
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License Number State | TX
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