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566 Fm 1960 Rd W Ste 400 Houston TX 77090-3544 | |
| (202) 491-5781 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 566 Fm 1960 Rd W Ste 400, Houston, Texas |
| Authorized Official Name and Position | Carlos Rodquae Boston (OWNER) |
| Authorized Official Contact | 2024915781 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
566 Fm 1960 Rd W Ste 400 Houston TX 77090-3544 Ph: (202) 491-5781 | 566 Fm 1960 Rd W Ste 400 Houston TX 77090-3544 Ph: (202) 491-5781 |
| NPI Number | 1871838029 |
|---|---|
| Provider Enumeration Date | 11/28/2012 |
| Last Update Date | 11/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871838029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 25589 (Texas) | Primary |
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