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2400 Augusta Dr Ste 276 Houston TX 77057-4922 | |
(346) 487-8216 | |
(346) 487-8216 |
Full Name | |
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Speciality | Dentist |
Location | 2400 Augusta Dr Ste 276, Houston, Texas |
Authorized Official Name and Position | Andres Martinez Porras (DIRECTOR) |
Authorized Official Contact | 3464878216 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7500 San Felipe St Ste 325 Houston TX 77063-1700 Ph: (346) 487-8216 | 2400 Augusta Dr Ste 276 Houston TX 77057-4922 Ph: (346) 487-8216 |
NPI Number | 1770260283 |
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Provider Enumeration Date | 06/28/2023 |
Last Update Date | 09/16/2024 |
Medicare PECOS PAC ID | 8224490842 |
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Medicare Enrollment ID | O20230815000362 |
Identifier | Type | State | Issuer |
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1770260283 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223X2210X | Dentist - Orofacial Pain | (* (Not Available)) | Primary |
Provider Name | Andres Martinez Porras |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1841940186 PECOS PAC ID: 0042672669 Enrollment ID: I20230815000613 |
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