1265685812 NPI number — PALUK-ECHEVERRIA DENTAL PC

Table of content: (NPI 1265685812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265685812 NPI number — PALUK-ECHEVERRIA DENTAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALUK-ECHEVERRIA DENTAL PC
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:
1265685812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 POST OAK BLVD
Provider Second Line Business Mailing Address:
#506
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77056-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-398-2882
Provider Business Mailing Address Fax Number:
713-877-1307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 POST OAK PKWY
Provider Second Line Business Practice Location Address:
#1190
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-398-2663
Provider Business Practice Location Address Fax Number:
713-877-1307
Provider Enumeration Date:
10/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALUK
Authorized Official First Name:
SERGIO
Authorized Official Middle Name:
FABIAN
Authorized Official Title or Position:
DENTIST/PRESIDENT
Authorized Official Telephone Number:
713-398-2882

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  21665 , 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)