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8200 Wednesbury Ln Ste 108 Houston TX 77074-2931 | |
| (713) 772-2141 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 8200 Wednesbury Ln Ste 108, Houston, Texas |
| Authorized Official Name and Position | Shervin Amini (CREDENTIALING SPCIALIST) |
| Authorized Official Contact | 7136478199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8200 Wednesbury Ln Ste 108 Houston TX 77074-2931 Ph: (713) 772-2141 | 8200 Wednesbury Ln Ste 108 Houston TX 77074-2931 Ph: (713) 772-2141 |
| NPI Number | 1629451653 |
|---|---|
| Provider Enumeration Date | 07/08/2015 |
| Last Update Date | 08/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629451653 | NPI | - | NPPES |
| 23077 | Other | TX | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 23077 (Texas) | Primary |
| 251B00000X | Case Management | 23077 (Texas) | Secondary |
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