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General NPI Number Information
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NPI Number | 1972045722
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VIEW DENTAL
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 2929 FOUNTAIN VIEW DR
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City | HOUSTON
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State | TX
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Zip | 77057-6105
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Country | US
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Telephone | 713-784-8235
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Fax | 713-974-0850
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Provider Business Mailing Address
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Address Line | 2929 FOUNTAIN VIEW DR
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City | HOUSTON
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State | TX
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Zip | 77057-6105
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Country | US
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Telephone | 713-784-8235
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Fax | 713-974-0850
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Authorized Official
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Title or Position | OWNER
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Name | DR. NISHANO THOMAS
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Credential | D.D.S.
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Telephone | 713-784-8235
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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 | TX27229
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | TX10126
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License Number State | TX
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