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General NPI Number Information
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NPI Number | 1851641476
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Entity Type | Organization
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Legal Business Name | LA MICHOACANA DENTAL CLINIC#3 LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 6333 BARKER CYPRESS RD SUITE A
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City | HOUSTON
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State | TX
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Zip | 77084-1625
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Country | US
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Telephone | 713-691-1188
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Fax | 713-691-1196
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Provider Business Mailing Address
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Address Line | 6333 BARKER CYPRESS RD SUITE A
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City | HOUSTON
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State | TX
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Zip | 77084-1625
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Country | US
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Telephone | 713-691-1188
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Fax | 713-691-1196
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADELINA PABLOS MONTY
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Credential | DDS
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Telephone | 713-691-1188
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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 | 18185
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License Number State | TX
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