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2280 Holcombe Blvd Houston TX 77030-4224 | |
| (713) 799-1400 | |
| (713) 799-1751 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2280 Holcombe Blvd, Houston, Texas |
| Authorized Official Name and Position | Derek Tillman (PRESIDENT/CEO) |
| Authorized Official Contact | 7132945774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5701 Kiam St Unit F Houston TX 77007-1141 Ph: (713) 294-5774 | 2280 Holcombe Blvd Houston TX 77030-4224 Ph: (713) 799-1400 |
| NPI Number | 1093951626 |
|---|---|
| Provider Enumeration Date | 01/03/2009 |
| Last Update Date | 01/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093951626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 23294 (Texas) | Primary |
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