| Time Square Dental Group | |
|
4450 E Sam Houston Pkwy S Suite H2 Pasadena TX 77505-3950 | |
| (713) 910-7779 | |
| (713) 910-7760 |
| Full Name | Time Square Dental Group |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 4450 E Sam Houston Pkwy S, Pasadena, Texas |
| Authorized Official Name and Position | Razan Daccak (OWNER) |
| Authorized Official Contact | 7139107779 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Time Square Dental Group Po Box 460182 Houston TX 77056-8182 Ph: () - | Time Square Dental Group 4450 E Sam Houston Pkwy S Suite H2 Pasadena TX 77505-3950 Ph: (713) 910-7779 |
| NPI Number | 1225369077 |
|---|---|
| Provider Enumeration Date | 01/19/2010 |
| Last Update Date | 01/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225369077 | NPI | - | NPPES |
| 190182901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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