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NPI Code Detail

MEDICARE: RAD DENT, PLLC

MEDICARE: RAD DENT, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1417678822
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAD DENT, PLLC
Provider Business Mailing Address
First Line : 10786 BELLAIRE BLVD STE A
Second Line :
City : HOUSTON
State : TX
Zip : 77072-2745
Country : US
Telephone Number : 281-494-0900
Fax Number : 281-495-9162
Provider Business Practice Location Address
First Line : 10786 BELLAIRE BLVD STE A
Second Line :
City : HOUSTON
State : TX
Zip : 77072-2745
Country : US
Telephone Number : 281-494-0900
Fax Number : 281-495-9162
Authorized Official
Title or Position : OWNER
Name : STEPHEN LON TAN
Credential : DMD
Telephone Number : 832-364-1593
Provider Enumeration Date : 09/06/2022
Last Update Date : 09/06/2022

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Directions to “RAD DENT, PLLC ” Practice Location

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