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General NPI Number Information
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NPI Number | 1750760179
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Entity Type | Organization
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Legal Business Name | VILLAGE PARK FAMILY DENTAL LLC
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 12617 LOUETTA RD STE 204
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City | CYPRESS
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State | TX
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Zip | 77429-5212
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Country | US
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Telephone | 281-336-1131
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Fax | 888-433-8848
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Provider Business Mailing Address
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Address Line | 12617 LOUETTA RD STE 204
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City | CYPRESS
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State | TX
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Zip | 77429-5212
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Country | US
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Telephone | 281-336-1131
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Fax | 888-433-8848
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SABA AHMED
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Credential | DDS
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Telephone | 218-336-1131
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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 | 23508
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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