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779 Normandy St Ste 113 Houston TX 77015-3441 | |
| (510) 676-4783 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 779 Normandy St Ste 113, Houston, Texas |
| Authorized Official Name and Position | Bilkisu Idakoji (PRESIDENT) |
| Authorized Official Contact | 5106764783 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1515 Asbury St Houston TX 77007-3112 Ph: (510) 676-4783 | 779 Normandy St Ste 113 Houston TX 77015-3441 Ph: (510) 676-4783 |
| NPI Number | 1396227815 |
|---|---|
| Provider Enumeration Date | 08/30/2018 |
| Last Update Date | 08/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396227815 | NPI | - | NPPES |
| 1710115894 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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