1821184730 NPI number — HOUSTON PROSTHODONTIC ASSOCIATES

Table of content: (NPI 1821184730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821184730 NPI number — HOUSTON PROSTHODONTIC ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON PROSTHODONTIC 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:
NEAL B. GITTLEMAN D.M.D.
Provider Other Organization Name Type Code:
4
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:
1821184730
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:
50 BRIAR HOLLOW LN
Provider Second Line Business Mailing Address:
SUITE 150 WEST
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77027-9300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-993-0003
Provider Business Mailing Address Fax Number:
713-993-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 BRIAR HOLLOW LN
Provider Second Line Business Practice Location Address:
SUITE 150 WEST
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-993-0003
Provider Business Practice Location Address Fax Number:
713-993-0223
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GITTLEMAN
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-993-0003

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  13876 , 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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