| None | |
|
4126 Southwest Fwy Suite 1610 Houston TX 77027-7310 | |
| (713) 777-6453 | |
| (713) 850-7847 |
| Full Name | None |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4126 Southwest Fwy, Houston, Texas |
| Authorized Official Name and Position | Ronald Jenard Moon (PRESIDENT/DENTIST) |
| Authorized Official Contact | 7127776453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 4126 Southwest Fwy Suite 1610 Houston TX 77027-7310 Ph: (713) 777-6453 | None 4126 Southwest Fwy Suite 1610 Houston TX 77027-7310 Ph: (713) 777-6453 |
| NPI Number | 1588909956 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 12/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588909956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 19552 (Texas) | Primary |
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