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4005 Broadway St Houston TX 77087-4703 | |
| (713) 644-4331 | |
| (713) 644-1975 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4005 Broadway St, Houston, Texas |
| Authorized Official Name and Position | Jay E Elliott (OWNER DENTIST) |
| Authorized Official Contact | 7136444331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4005 Broadway Houston TX 77087-4703 Ph: (713) 644-4331 | 4005 Broadway St Houston TX 77087-4703 Ph: (713) 644-4331 |
| NPI Number | 1902936966 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 03/31/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902936966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12723 (Texas) | Primary |
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