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1414 Eldridge Pkwy Houston TX 77077-1625 | |
| (832) 243-4302 | |
| (832) 486-9528 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1414 Eldridge Pkwy, Houston, Texas |
| Authorized Official Name and Position | Ali F Khan (CFO) |
| Authorized Official Contact | 7135026893 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1414 Eldridge Pkwy Houston TX 77077-1625 Ph: (832) 243-4302 | 1414 Eldridge Pkwy Houston TX 77077-1625 Ph: (832) 243-4302 |
| NPI Number | 1497099733 |
|---|---|
| Provider Enumeration Date | 11/26/2012 |
| Last Update Date | 11/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497099733 | NPI | - | NPPES |
| 614307189 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
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Your Houston Dentist Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2077 S Gessner Rd, Suite 125, Houston, TX 77063 Phone: 713-789-1200 Fax: 713-789-1219 | |