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General NPI Number Information
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NPI Number | 1871007732
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Entity Type | Organization
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Legal Business Name | MARVEL DENTISTRY PC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 1450 FRY RD
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City | HOUSTON
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State | TX
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Zip | 77084-5811
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Country | US
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Telephone | 281-398-2889
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Fax | 281-238-5978
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Provider Business Mailing Address
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Address Line | 1450 FRY RD
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City | HOUSTON
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State | TX
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Zip | 77084-5811
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Country | US
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Telephone | 281-398-2889
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Fax | 281-238-5978
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY K TA
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Credential | DMD
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Telephone | 281-398-2889
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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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