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General NPI Number Information
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NPI Number | 1922588029
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Entity Type | Organization
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Legal Business Name | FAV-ULOS DENTAL
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 8762 LONG POINT RD STE 102
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City | HOUSTON
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State | TX
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Zip | 77055-3016
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Country | US
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Telephone | 713-468-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 8762 LONG POINT RD STE 102
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City | HOUSTON
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State | TX
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Zip | 77055-3016
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Country | US
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Telephone | 713-468-1400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FABIOLA GARCIA DE ROCHA
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Credential | DR
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Telephone | 713-468-1400
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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 | 30122
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License Number State | TX
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