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5206 Irvington Blvd Ste. A Houston TX 77009-1932 | |
| (713) 742-0355 | |
| (713) 742-0357 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5206 Irvington Blvd, Houston, Texas |
| Authorized Official Name and Position | Emma Virginia Lopez (OWNER PRESIDENT) |
| Authorized Official Contact | 7137420355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5206 Irvington Blvd Ste. A Houston TX 77009-1932 Ph: (713) 742-0355 | 5206 Irvington Blvd Ste. A Houston TX 77009-1932 Ph: (713) 742-0355 |
| NPI Number | 1134275787 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 03/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134275787 | NPI | - | NPPES |
| 009451801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18695 (Texas) | Primary |
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