| Lighthouse Surgical Holdings Pllc | |
|
6560 Fannin St Ste 614 Houston TX 77030-2727 | |
| (713) 790-1995 | |
| (713) 790-9562 |
| Full Name | Lighthouse Surgical Holdings Pllc |
|---|---|
| Speciality | Dentist |
| Location | 6560 Fannin St Ste 614, Houston, Texas |
| Authorized Official Name and Position | Justin J Seaman (OWNER) |
| Authorized Official Contact | 7137901995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Surgical Holdings Pllc Po Box 248968 Oklahoma City OK 73124-8968 Ph: (877) 667-7669 | Lighthouse Surgical Holdings Pllc 6560 Fannin St Ste 614 Houston TX 77030-2727 Ph: (713) 790-1995 |
| NPI Number | 1477128395 |
|---|---|
| Provider Enumeration Date | 05/24/2021 |
| Last Update Date | 05/24/2021 |
| Medicare PECOS PAC ID | 0244620599 |
|---|---|
| Medicare Enrollment ID | O20211202000758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477128395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Terry D Taylor |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1891797130 PECOS PAC ID: 8527243567 Enrollment ID: I20110506000207 |
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