1780850701 NPI number — CRESCENTWOOD DENTAL ASSOCIATES

Table of content: (NPI 1780850701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780850701 NPI number — CRESCENTWOOD DENTAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESCENTWOOD DENTAL ASSOCIATES
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:
1780850701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7002 RIVERBROOK DR
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-6530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-343-5656
Provider Business Mailing Address Fax Number:
281-343-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7002 RIVERBROOK DR
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-343-5656
Provider Business Practice Location Address Fax Number:
281-343-5657
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HELAL
Authorized Official First Name:
RAMZEY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-343-5656

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19319 , 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)

  • Identifier: 1439630-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com