| Southern Dental Associates - Palm Center | |
|
5703 Martin Luther King Jr Blvd Houston TX 77021-3224 | |
| (713) 644-6594 | |
| (713) 644-1477 |
| Full Name | Southern Dental Associates - Palm Center |
|---|---|
| Speciality | Dentist |
| Location | 5703 Martin Luther King Jr Blvd, Houston, Texas |
| Authorized Official Name and Position | David D. Lewis (PRESIDENT) |
| Authorized Official Contact | 7136817920 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Dental Associates - Palm Center 2500 Central Pkwy Suite P Houston TX 77092-7733 Ph: (713) 681-7920 | Southern Dental Associates - Palm Center 5703 Martin Luther King Jr Blvd Houston TX 77021-3224 Ph: (713) 644-6594 |
| NPI Number | 1144236506 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 08/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144236506 | NPI | - | NPPES |
| 136359004 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 9517 (Texas) | Primary |
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