1871762039 NPI number — DR. TERESITA E LADRILLO DMD MPH

Table of content: DR. TERESITA E LADRILLO DMD MPH (NPI 1871762039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871762039 NPI number — DR. TERESITA E LADRILLO DMD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LADRILLO
Provider First Name:
TERESITA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LADRILLO
Provider Other First Name:
TESS
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871762039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88361
Provider Second Line Business Mailing Address:
CITY OF HOUSTON HEALTH & HUMAN SERVICES
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77288-8861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-794-9104
Provider Business Mailing Address Fax Number:
713-798-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-547-8079
Provider Business Practice Location Address Fax Number:
713-547-8130
Provider Enumeration Date:
02/21/2008

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:  23164 , 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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