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15002 Ella Blvd Ste 42 Houston TX 77090-5622 | |
| (281) 872-9696 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15002 Ella Blvd Ste 42, Houston, Texas |
| Authorized Official Name and Position | Supritha Hangal (OWNER) |
| Authorized Official Contact | 2162697199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15002 Ella Blvd Ste 42 Houston TX 77090-5622 Ph: (281) 872-9696 | 15002 Ella Blvd Ste 42 Houston TX 77090-5622 Ph: (281) 872-9696 |
| NPI Number | 1174074132 |
|---|---|
| Provider Enumeration Date | 10/14/2016 |
| Last Update Date | 10/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174074132 | NPI | - | NPPES |
| 304469526 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 28426 (Texas) | Primary |
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