| |
17320 W Grand Pkwy S Ste B Sugar Land TX 77479-2667 | |
(832) 595-2505 | |
(832) 595-2290 |
Full Name | |
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Speciality | Dentist |
Location | 17320 W Grand Pkwy S Ste B, Sugar Land, Texas |
Authorized Official Name and Position | Liyen Lin Keen (PRESIDENT) |
Authorized Official Contact | 8325952505 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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17320 W Grand Pkwy S Ste B Sugar Land TX 77479-2667 Ph: (832) 595-2505 | 17320 W Grand Pkwy S Ste B Sugar Land TX 77479-2667 Ph: (832) 595-2505 |
NPI Number | 1053314476 |
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Provider Enumeration Date | 05/31/2005 |
Last Update Date | 09/12/2024 |
Medicare PECOS PAC ID | 2466826672 |
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Medicare Enrollment ID | O20230329001687 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053314476 | NPI | - | NPPES |
00001727583 | Other | TX | UNITED CONCORDIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
Dental Specialist Of Texas Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15200 Southwest Fwy Ste 120, Sugar Land, TX 77478 Phone: 281-494-2477 | |
Avalon Dental Group, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2205 Williams Trace Blvd, Ste 108, Sugar Land, TX 77478 Phone: 281-240-5559 Fax: 281-240-5557 |