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6011 W Main St Ste A101 League City TX 77573-7541 | |
| (281) 338-6559 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 6011 W Main St Ste A101, League City, Texas |
| Authorized Official Name and Position | Erika Melissa Menjivar (SR. CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4695966137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | 6011 W Main St Ste A101 League City TX 77573-7541 Ph: (281) 338-6559 |
| NPI Number | 1407682511 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 09/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407682511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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