| Space City Pediatric Dentistry | |
|
18174 Gulf Fwy Ste 100 Friendswood TX 77546-2722 | |
| (281) 484-7732 | |
| (888) 397-0197 |
| Full Name | Space City Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 18174 Gulf Fwy Ste 100, Friendswood, Texas |
| Authorized Official Name and Position | Bret A Ibarra (OWNER) |
| Authorized Official Contact | 2814847732 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Space City Pediatric Dentistry 18174 Gulf Fwy Ste 100 Friendswood TX 77546-2722 Ph: (281) 484-7732 | Space City Pediatric Dentistry 18174 Gulf Fwy Ste 100 Friendswood TX 77546-2722 Ph: (281) 484-7732 |
| NPI Number | 1487811659 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 10/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487811659 | NPI | - | NPPES |
| 220062801 | Medicaid | TX | |
| 009757801 | Medicaid | TX | |
| 1487811659 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 10310 (Texas) | Primary |
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