1427055292 NPI number — PERIO HEALTH PROFESSIONALS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427055292 NPI number — PERIO HEALTH PROFESSIONALS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERIO HEALTH PROFESSIONALS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427055292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 S GESSNER RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77063-7247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-783-5442
Provider Business Mailing Address Fax Number:
713-952-0614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 S GESSNER RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77063-7247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-783-5442
Provider Business Practice Location Address Fax Number:
713-952-0614
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCGUIRE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
713-783-5442

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  11568 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0300X , with the licence number: 20405 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com