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NPI Code Detail

MEDICARE: LAUDER ROAD DENTAL CENTER INC

MEDICARE: LAUDER ROAD DENTAL CENTER INC
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
1122300000XDentist11108TX

General Provider Information

NPI Number : 1871608471
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAUDER ROAD DENTAL CENTER INC
Provider Business Mailing Address
First Line : 2623 LAUDER ROAD
Second Line :
City : HOUSTON
State : TX
Zip : 77039-3119
Country : US
Telephone Number : 281-449-4439
Fax Number : 281-449-7224
Provider Business Practice Location Address
First Line : 2623 LAUDER ROAD
Second Line :
City : HOUSTON
State : TX
Zip : 77039-3119
Country : US
Telephone Number : 281-449-4439
Fax Number : 281-449-7224
Authorized Official
Title or Position : PRESIDENT
Name : MR. RONALD LEE MADDOX
Credential : DDS
Telephone Number : 281-449-4439
Provider Enumeration Date : 08/21/2006
Last Update Date : 08/22/2020

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Directions to “LAUDER ROAD DENTAL CENTER INC ” Practice Location

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