1093887242 NPI number — HENRY BRICK POMEROY III DMD

Table of content: HENRY BRICK POMEROY III DMD (NPI 1093887242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093887242 NPI number — HENRY BRICK POMEROY III DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POMEROY
Provider First Name:
HENRY
Provider Middle Name:
BRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POMEROY
Provider Other First Name:
H
Provider Other Middle Name:
BRICK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093887242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 AVENUE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77551-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-762-8884
Provider Business Mailing Address Fax Number:
409-740-3038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 AVENUE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77551-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-762-8884
Provider Business Practice Location Address Fax Number:
409-740-3038
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12688 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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