1114143104 NPI number — DR. MARY ANN GRACE SAGULLO DDS

Table of content: DR. MARY ANN GRACE SAGULLO DDS (NPI 1114143104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114143104 NPI number — DR. MARY ANN GRACE SAGULLO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAGULLO
Provider First Name:
MARY ANN
Provider Middle Name:
GRACE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1114143104
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:
22235 RUSSELL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-689-1760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 N LOOP WEST
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-861-3231
Provider Business Practice Location Address Fax Number:
713-426-1720
Provider Enumeration Date:
04/18/2007

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: 122300000X , with the licence number:  20093 , 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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