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General NPI Number Information
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NPI Number | 1750790127
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Entity Type | Organization
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Legal Business Name | SERENITY DENTAL CARE PLLC
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 6519 FM 1488 RD SUITE 505
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City | MAGNOLIA
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State | TX
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Zip | 77354-3263
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Country | US
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Telephone | 281-305-8835
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Fax |
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Provider Business Mailing Address
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Address Line | 6519 FM 1488 RD SUITE 505
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City | MAGNOLIA
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State | TX
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Zip | 77354-3263
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Country | US
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Telephone | 281-305-8835
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JEFFERY CHUNG
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Credential |
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Telephone | 281-305-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30358
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License Number State | TX
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