1639356355 NPI number — MATTHEW W PLUMMER JR DMD MPH DAPHNE L BROOKS REED DMD INC

Table of content: (NPI 1639356355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639356355 NPI number — MATTHEW W PLUMMER JR DMD MPH DAPHNE L BROOKS REED DMD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW W PLUMMER JR DMD MPH DAPHNE L BROOKS REED DMD INC
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:
COSMETIC DENTISTRY OF TEXAS
Provider Other Organization Name Type Code:
3
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:
1639356355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 CRAWFORD STREET
Provider Second Line Business Mailing Address:
SUITE #204
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-757-1948
Provider Business Mailing Address Fax Number:
713-757-9835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CRAWFORD STREET
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-757-1948
Provider Business Practice Location Address Fax Number:
713-757-9835
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PLUMMER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT OWNER OPERATOR
Authorized Official Telephone Number:
713-757-1948

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10664TX , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 13442TX , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 21817TX , 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)





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