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General NPI Number Information
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NPI Number | 1871980318
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Entity Type | Organization
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Legal Business Name | JULIO GAITAN D.D.S., P.A.
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 19100 W LAKE HOUSTON PKWY SUITE 103
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City | HUMBLE
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State | TX
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Zip | 77346-5138
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Country | US
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Telephone | 214-300-1427
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Fax |
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Provider Business Mailing Address
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Address Line | 215 N CRIMSON CLOVER CIR
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City | SPRING
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State | TX
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Zip | 77381-3887
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Country | US
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Telephone | 214-796-8130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIO GAITAN
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Credential | D.D.S
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Telephone | 214-796-8130
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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 |
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License Number State | TX
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