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General NPI Number Information
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NPI Number | 1962848911
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Entity Type | Organization
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Legal Business Name | JUSTIN DENTAL HEIGHTS PLLC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 107 YALE ST STE 300
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City | HOUSTON
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State | TX
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Zip | 77007-3730
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Country | US
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Telephone | 832-900-2071
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Fax | 832-900-2072
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Provider Business Mailing Address
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Address Line | 107 YALE ST STE 300
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City | HOUSTON
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State | TX
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Zip | 77007-3730
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Country | US
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Telephone | 832-900-2071
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Fax | 832-900-2072
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Authorized Official
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Title or Position | SR CREDENTIALING TEAM LEAD
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Name | JENNY GARCIA ROCHA
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Credential |
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Telephone | 972-869-3789
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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 | 25571
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License Number State | TX
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