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3603 South Front Street Suite 107 Brookshire TX 77423-9457 | |
| (281) 934-1010 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3603 South Front Street, Brookshire, Texas |
| Authorized Official Name and Position | Mohammad Moridnia (VICE PRESIDENT/ DENTIST) |
| Authorized Official Contact | 2819341010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3603 South Front Street Suite 107 Brookshire TX 77423-9457 Ph: (281) 934-1010 | 3603 South Front Street Suite 107 Brookshire TX 77423-9457 Ph: (281) 934-1010 |
| NPI Number | 1316371354 |
|---|---|
| Provider Enumeration Date | 08/27/2013 |
| Last Update Date | 08/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316371354 | NPI | - | NPPES |
| 2828576 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 27064 (Texas) | Primary |
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