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General NPI Number Information
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NPI Number | 1962760439
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Entity Type | Organization
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Legal Business Name | SPROUT PEDIATRIC DENTISTRY, PINC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 9659 N SAM HOUSTON PKWY E SUITE 103
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City | HUMBLE
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State | TX
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Zip | 77396-1529
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Country | US
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Telephone | 800-764-1829
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Fax |
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Provider Business Mailing Address
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Address Line | 9659 N SAM HOUSTON PKWY E SUITE 103
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City | HUMBLE
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State | TX
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Zip | 77396-1529
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Country | US
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Telephone | 800-764-1829
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHUNDA L THOMPSON
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Credential | DDS
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Telephone | 800-764-1829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 24833
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23564
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24833
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License Number State | TX
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