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4910 Willowbend Blvd Ste C Houston TX 77035-3227 | |
| (713) 729-1813 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4910 Willowbend Blvd Ste C, Houston, Texas |
| Authorized Official Name and Position | Amanda Lightfoot (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Contact | 2147020708 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15660 Dallas Pkwy Ste 925 Dallas TX 75248-3323 Ph: (214) 702-0729 | 4910 Willowbend Blvd Ste C Houston TX 77035-3227 Ph: (713) 729-1813 |
| NPI Number | 1730646571 |
|---|---|
| Provider Enumeration Date | 02/28/2019 |
| Last Update Date | 03/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730646571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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