| |
8880 Bellaire Blvd Ste F Houston TX 77036-4621 | |
(281) 888-5150 | |
(281) 888-5584 |
Full Name | |
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Speciality | Dentist |
Location | 8880 Bellaire Blvd Ste F, Houston, Texas |
Authorized Official Name and Position | Dongfang Li (OWNER/DENTIST) |
Authorized Official Contact | 2818885150 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8880 Bellaire Blvd Ste F Houston TX 77036-4621 Ph: (281) 888-5150 | 8880 Bellaire Blvd Ste F Houston TX 77036-4621 Ph: (281) 888-5150 |
NPI Number | 1285071746 |
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Provider Enumeration Date | 05/23/2013 |
Last Update Date | 06/24/2023 |
Medicare PECOS PAC ID | 8628440179 |
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Medicare Enrollment ID | O20230208003154 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285071746 | NPI | - | NPPES |
1659602993 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 23786 (Texas) | Primary |
Provider Name | Dongfang Li |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1659602993 PECOS PAC ID: 1658678826 Enrollment ID: I20230208003195 |
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