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General NPI Number Information
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NPI Number | 1790417111
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Entity Type | Organization
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Legal Business Name | GH RADFORD DDS & ASSOC., INC
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 9330 BROADWAY ST STE 320B
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City | PEARLAND
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State | TX
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Zip | 77584-7895
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Country | US
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Telephone | 713-340-0625
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Fax | 713-340-1881
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Provider Business Mailing Address
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Address Line | 3216 OAKMONT ST
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City | HOUSTON
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State | TX
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Zip | 77021-1131
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Country | US
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Telephone | 832-723-5052
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Fax |
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Authorized Official
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Title or Position | OFFICE CREDENTIALING SPECIALIST
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Name | PHYLLIS PRESTON
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Credential |
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Telephone | 713-291-3474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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