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General NPI Number Information
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NPI Number | 1811622699
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Entity Type | Organization
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Legal Business Name | G.O. DENTAL CLINIC PLLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 825 TOWN AND COUNTRY LN STE 1200
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City | HOUSTON
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State | TX
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Zip | 77024-2246
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Country | US
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Telephone | 832-930-4646
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Fax | 832-698-9553
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Provider Business Mailing Address
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Address Line | 825 TOWN AND COUNTRY LN STE 1200
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City | HOUSTON
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State | TX
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Zip | 77024-2246
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Country | US
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Telephone | 832-930-4646
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Fax | 832-698-9553
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PAUL KWAUK
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Credential |
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Telephone | 832-930-4005
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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 |
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License Number State |
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