| Gulf Family Dental Pc | |
|
3701 Shaver St Pasadena TX 77504-2601 | |
| (713) 946-8200 | |
| (713) 946-8203 |
| Full Name | Gulf Family Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 3701 Shaver St, Pasadena, Texas |
| Authorized Official Name and Position | Abdoul R Koroni (PRESIDENT) |
| Authorized Official Contact | 7139468200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Family Dental Pc 3701 Shaver St. Pasadena TX 77504 Ph: (713) 946-8200 | Gulf Family Dental Pc 3701 Shaver St Pasadena TX 77504-2601 Ph: (713) 946-8200 |
| NPI Number | 1356733794 |
|---|---|
| Provider Enumeration Date | 02/23/2015 |
| Last Update Date | 02/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356733794 | NPI | - | NPPES |
| 0078305-02 | Medicaid | TX | |
| 0078305-04 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19896 (Texas) | Primary |
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