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General NPI Number Information
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NPI Number | 1851563183
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Entity Type | Organization
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Legal Business Name | CINCO RANCH ENDODONTICS
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 23922 CINCO VILLAGE CENTER BLVD SUITE 240
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City | KATY
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State | TX
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Zip | 77494-6619
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Country | US
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Telephone | 281-371-3636
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Fax | 281-371-3640
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Provider Business Mailing Address
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Address Line | 23922 CINCO VILLAGE CENTER BLVD SUITE 240
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City | KATY
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State | TX
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Zip | 77494-6619
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Country | US
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Telephone | 281-371-3636
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Fax | 281-371-3640
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN BERTEAUX
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Credential | DMD
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Telephone | 281-371-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 23109
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License Number State | TX
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