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1500 S Dairy Ashford St 1500 South Dairy Ashford Ste. 114 Houston TX 77077-3854 | |
| (281) 558-3440 | |
| (281) 558-3448 |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 1500 S Dairy Ashford St, Houston, Texas |
| Authorized Official Name and Position | Tracy Manning Clark (PRESIDENT) |
| Authorized Official Contact | 2815583440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1500 S Dairy Ashford St 1500 South Dairy Ashford Ste. 114 Houston TX 77077-3854 Ph: (281) 558-3440 | 1500 S Dairy Ashford St 1500 South Dairy Ashford Ste. 114 Houston TX 77077-3854 Ph: (281) 558-3440 |
| NPI Number | 1295889863 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295889863 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 15603 (Texas) | Primary |
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