| Pasadena Dental & Orthodontics Pllc | |
|
1611 Spencer Hwy C & D1 South Houston TX 77587-3772 | |
| (817) 529-8151 | |
| (817) 529-8156 |
| Full Name | Pasadena Dental & Orthodontics Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1611 Spencer Hwy, South Houston, Texas |
| Authorized Official Name and Position | Raffy Kouyoumdjian (OWNER) |
| Authorized Official Contact | 8175298151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pasadena Dental & Orthodontics Pllc 1611 Spencer Hwy C & D1 South Houston TX 77587-3772 Ph: (817) 529-8151 | Pasadena Dental & Orthodontics Pllc 1611 Spencer Hwy C & D1 South Houston TX 77587-3772 Ph: (817) 529-8151 |
| NPI Number | 1316324155 |
|---|---|
| Provider Enumeration Date | 04/30/2015 |
| Last Update Date | 04/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316324155 | NPI | - | NPPES |
| 182419510 | Medicaid | TX | |
| 182419513 | Medicaid | TX | |
| 182419515 | Medicaid | TX | |
| 182419514 | Medicaid | TX | |
| 182419517 | Medicaid | TX | |
| 182419511 | Medicaid | TX | |
| 182419516 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 23066 (Texas) | Primary |
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