| Eagle Dental P.c. | |
|
12609 S Gessner Dr Houston TX 77071-2803 | |
| (713) 774-6700 | |
| (713) 774-6704 |
| Full Name | Eagle Dental P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12609 S Gessner Dr, Houston, Texas |
| Authorized Official Name and Position | Davin E Odia (OWNER) |
| Authorized Official Contact | 8327902223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Dental P.c. 12609 S. Gessner Drive Ste. F Houston TX 77071-2803 Ph: (713) 774-6700 | Eagle Dental P.c. 12609 S Gessner Dr Houston TX 77071-2803 Ph: (713) 774-6700 |
| NPI Number | 1073832291 |
|---|---|
| Provider Enumeration Date | 05/27/2010 |
| Last Update Date | 06/23/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073832291 | NPI | - | NPPES |
| 190960801 | Medicaid | TX | |
| B22575-01 | Other | CHIP | |
| 214288701 | Medicaid | TX | |
| B22575-02 | Other | CHIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 22575 (Texas) | Primary |
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