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255 Westlake Park Blvd Houston TX 77079-0001 | |
| (281) 310-5040 | |
| (281) 310-5045 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 255 Westlake Park Blvd, Houston, Texas |
| Authorized Official Name and Position | Ulises Delacruz (PRESIDENT) |
| Authorized Official Contact | 2102635749 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 255 Westlake Park Blvd Houston TX 77079-0001 Ph: (281) 310-5040 |
| NPI Number | 1366728859 |
|---|---|
| Provider Enumeration Date | 10/27/2011 |
| Last Update Date | 07/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366728859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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