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Provider Information for 1205157567

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1205157567

Calendar   Last Updated:  2021-06-01
  Certification Date:  2021-06-01


Name Value
NPI 1205157567
Enumeration Date 2010-06-21
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2015 BOULDER SPRINGS LN
HOUSTON, TX 77077-1776
United States

Phone: 917-687-2839 | Fax: 832-595-9003
View Map External Link
Primary Practice Address 7975 W GRAND PKWY S STE 120
RICHMOND, TX 77407-8603
United States

Phone: 832-595-9000 | Fax: 832-595-9003
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice TX 31041