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General NPI Number Information
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NPI Number | 1770088056
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Entity Type | Organization
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Legal Business Name | PURA DENTAL
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 1507 GESSNER DR. STE B
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City | HOUSTON
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State | TX
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Zip | 77080
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Country | US
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Telephone | 281-698-0588
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 GESSNER RD STE A
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City | HOUSTON
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State | TX
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Zip | 77080-7589
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Country | US
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Telephone | 832-875-7269
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SALEHA REHMAN
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Credential | DDS
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Telephone | 832-875-7269
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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 | 24189
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License Number State | TX
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