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1002 N Loop 336 W Conroe TX 77301-1829 | |
| (936) 760-3050 | |
| (936) 441-3068 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1002 N Loop 336 W, Conroe, Texas |
| Authorized Official Name and Position | Kenneth Osamor (PRESIDENT) |
| Authorized Official Contact | 9367603050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1002 N Loop 336 W Conroe TX 77301-1829 Ph: (936) 760-3050 | 1002 N Loop 336 W Conroe TX 77301-1829 Ph: (936) 760-3050 |
| NPI Number | 1265648984 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 02/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265648984 | NPI | - | NPPES |
| 181571401 | Medicaid | TX | |
| 181 | Medicaid | TX | |
| 21886 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 21886 (Texas) | Primary |
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